E.E. Sanchez3, R. Ryncarz2, B. Lai2, A. Muhki1, J. Vosswinkel1,3, D. Ohngemach2, R. Jawa1,3 1Stony Brook University Medical Center, Division Of Trauma, Emergency Surgery, And Surgical Critical Care/Department Of Surgery/SBUH, Stony Brook, NY, USA 2Stony Brook University Medical Center, Division Of Interventional Radiology/Department Of Radiology/SBUH, Stony Brook, NY, USA 3Stony Brook University Medical Center, Renaissance School Of Medicine At Stony Brook Unversity, Stony Brook, NY, USA
Introduction:
Angioembolization for blunt abdominal and pelvic traumatic injury is a well-established practice across trauma hospitals in the United States. We examined the 8-year experience at a level 1 trauma center to assess patient outcomes.
Methods:
Retrospective study of adults age 18 and older with blunt abdominal and pelvic trauma admitted to a level 1 trauma center who underwent angiography for hemorrhage control between 2016-2023. Univariate analyses of demographics and outcomes were assessed.
Results:
During the study period, there were 12,914 adult blunt trauma admissions. Of these, 173 patients underwent Interventional Radiology angiography exclusively for abdominopelvic injuries. The most common mechanisms of injury were MVC/MCC (50.9%) followed by a fall (30.6%). Their median age was 56 years and 62.4% were males. Their median Injury Severity Score (ISS) was 25 (16, 34) and their median Shock Index was 0.77 (0.61, 0.93), with 67.6% having abdomen abbreviated injury score (AIS) >=3, 52.6% with chest AIS >=3, 45.1% with extremity AIS >=3, and 16.8% with head/neck AIS >=3.
As further evidence of severe injury, 47.4% required packed red blood cell (PRBC) transfusion within 4 hours, and 68.2% required PRBC within 24 hours. Concomitantly, 87.9% required intensive care unit (ICU) admission with a median ICU length of stay of 6 days (3, 11). The median hospital length of stay was 12 days (6, 19). The cohort had a 23.1% complication rate and in-hospital mortality rate of 8.1%. Approximately 51.4% were discharged to rehabilitation facilities and 37.0% were discharged to home.
Conclusion:
Angiography is a very infrequently required procedure. These results show that angioembolization for this cohort of critically injured patients, as assessed by shock index and ISS, in a level 1 trauma center was crucial in improving their outcomes. Despite the high injury severity, the vast majority were successfully discharged to home or to a rehabilitation facility. These findings underscore the importance of having angioembolization readily available in level 1 trauma centers to improve patient survival and recovery after blunt abdominal and pelvic trauma.