A Surgical Endovascular Trauma Service Increases Case Volume and Decreases Time to Hemostasis

Abstract

Objectives: The aim of this study was to evaluate the effect of a recently active endovascular trauma service (ETS) on case volume and time to hemostasis, as a complement to an existing interventional radiology (IR) service. Summary Background Data: Endovascular techniques are vital for trauma care, but timely access can be a challenge. There is a paucity of data on the effect of a multispecialty team for delivery of endovascular hemorrhage control. Methods: The electronic medical record of trauma patients undergoing endovascular procedures between 2013 and 2018 was queried for provider type (IR or ETS). Case volume and rates were expressed per 100 monthly admissions, normalizing for seasonal variation. Interrupted time series analysis was used to model the case rate pre- and post-introduction of the ETS. Admission-to-procedure-time data were collected for pelvic angioembolization as a marker of patients requiring emergency hemostasis. Results: During 6 years, 1274 admission episodes required endovascular interventions. Overall case volume increased from 2.7 to 3.6 at a rate of 0.006 (P = 0.734) after introduction of the ETS. IR case volume decreased from 3.3 to 2.6 at a rate of 0.03 (P = 0.063). ETS case volume increased at a rate of 0.048 (P < 0.001), which was significantly different from the IR trend (P < 0.001). Median (interquartile range) time-to-procedure (hours) was significantly shorter for pelvic angioembolization [3.0 (4.4) vs 4.3 (3.6); P < 0.001] when ETS was compared to IR. Conclusion: A surgical ETS increases case volume and decreases time to hemostasis for trauma patients requiring time sensitive interventions. Further work is required to assess patient outcome following this change.

Factors associated with prolonged procedure time of embolization for trauma patients

“…A decreased time to angioembolization has been much debated in published works, 5,19 however, previous reporting on the procedure time itself is scarce. 20,21 In this study, there was no delay to angiography compared with time to blood transfusion, and the time to angiography was shorter than in previous reports. 20,21 Shorter time to angiography could be related to the comparatively high proportion of patients (28%) who did not undergo blood transfusion and the lower total amount of blood transfused (median, 2 [interquartile range, 0-9] units) within 24 h from arrival.…”

Managing Vascular Trauma: Trauma Surgeons versus Vascular Surgeons

“…An in-house trauma service managing its own vascular trauma achieves more rapid control of hemorrhage, as unnecessary imaging studies can be avoided and patients can be taken swiftly to the operating room. 14 There is a need to address the gap between reported level of interest in vascular trauma and perceived competence in performing vascular procedures amongst trauma surgeons. The increasing use of endovascular techniques for trauma is contributing to the sense of inadequacy.…”

“…An in-house trauma service managing its own vascular trauma achieves more rapid control of hemorrhage, as unnecessary imaging studies can be avoided and patients can be taken swiftly to the operating room. 14…”

Factors Associated With Increased Mortality in Severe Abdominopelvic Injury

“…A multimodal approach that combines open and endovascular interventions has been posited as a method to achieve earlier hemorrhage control in the setting of NCTH and improve outcomes (28). However, this has not been readily adopted for a variety of reasons.…”