J. B. Miller1,2, R. Griffin1, K. Hendershot1 1University Of Alabama at Birmingham,Department Of Surgery,Birmingham, Alabama, USA 2Orlando Regional Medical Center,Department Of Surgical Education,Orlando, FL, USA
Introduction: Blood loss from pelvis fractures is a significant cause of morbidity and mortality. These patients sometimes require angioembolization and/or pelvis packing for hemorrhage control. A new institutional protocol was developed to facilitate more timely and appropriate control of hemorrhage, utilizing both Interventional Radiology (IR) and pelvis packing in the operating room (OR). Our hypothesis was that our protocol would increase utilization of both IR and OR and decrease time to IR.
Methods: A single-institution retrospective analysis was done of adult trauma patients with blunt pelvis fractures from January 1, 2015 to June 30, 2017. The new protocol was implemented midway through the study period. Data was analyzed prior to implementation and several months after protocol initiation.
Results: A total of 1083 patients had pelvis fractures during the study period. Of these, 85 patients underwent OR or IR procedures. Patients were excluded for unrelated OR or IR interventions, leaving 40 patients included in the final analysis.
In the pre-protocol time period there were 12 patients: 1 underwent OR pelvis packing followed by IR embolization and 11 underwent IR embolization alone. During the post-protocol period there were 28 patients: 2 underwent OR pelvis packing alone, 7 underwent OR pelvis packing followed by IR embolization, and 19 underwent IR embolization only.
Time to IR for pelvis hemorrhage in the pre-protocol period was 5 hours 6 minutes; post-protocol was 4 hours 30 min.
Conclusion: Our protocol resulted in increased utilization of both IR angioembolization and OR pelvis packing for patients with bleeding pelvis fractures; our time to IR decreased, although only by 36 minutes.