The effect of orthopaedic surgeons’ and interventional radiologists’ availability on the priority treatment sequence for hemodynamically unstable pelvic fractures: a survey of US Level I trauma centers

Abstract

Background: Most guidelines recommend both pelvic packing (PP) and angioembolization for hemodynamically unstable pelvic fractures, however their sequence varies. Some argue to use PP first because orthopaedic surgeons are more available than interventional radiologists; however, there is no data confirming this. Methods: This cross-sectional survey of 158 trauma medical directors at US Level I trauma centers collected the availability of orthopaedic surgeons and interventional radiologists, the number of orthopaedic trauma surgeons trained to manage pelvic fractures, and priority treatment sequence for hemodynamically unstable pelvic fractures. The study objective was to compare the availability of orthopaedic surgeons to interventional radiologists and describe how the availability of orthopaedic surgeons and interventional radiologists affects the treatment sequence for hemodynamically unstable pelvic fractures. Fisher's exact, chi-squared, and Kruskal-Wallis tests were used, alpha = 0.05. Results: The response rate was 25% (40/158). Orthopaedic surgeons (86%) were on-site more often than interventional radiologists (54%), p = 0.003. Orthopaedic surgeons were faster to arrive 39% of the time, and interventional radiologists were faster to arrive 6% of the time. There was a higher proportion of participants who prioritized PP before angioembolization at centers with above the average number (> 3) of orthopaedic trauma surgeons trained to manage pelvic fractures, as among centers with equal to or below average, p = 0.02. Arrival times for orthopaedic surgeons did not significantly predict prioritization of angioembolization or PP. Conclusions: Our results provide evidence that orthopaedic surgeons typically are more available than interventional radiologists but contrary to anecdotal evidence most participants used angioembolization first. Familiarity with the availability of orthopaedic surgeons and interventional radiologists may contribute to individual trauma center's treatment sequence.

A short decision time for transcatheter embolization can better associate mortality in patients with pelvic fracture: a retrospective study

“…Reportedly, the time to angioembolization is longer than the time to PPP, partly owing to the higher availability of orthopedic surgeons compared with that of interventional radiologists ( 7 , 12 , 33 ); furthermore, TAE may be delayed at night or on weekends based on reports of other catheter-based interventions ( 16 , 34 , 35 ). In our institution, interventional radiologists and the equipment required for TAE are available at all times.…”

A Short Decision Time For Transcatheter Embolization Can Better Predict Mortality In Patients With Pelvic Fracture

“…Several studies have reported that the time to angioembolization is longer than the time to PPP, which may be in part due to the high availability of orthopedic surgeons as compared to that of interventional radiologists [7,12,32], and TAE may be delayed at night or on weekends based on reports of other catheter-based interventions [16,33,34]. In our institution, interventional radiologists and the equipment required for TAE are available 24 h a day, 365 days a year.…”

A short decision time for transcatheter embolization can better predict mortality in patients with pelvic fracture

“…Several studies have reported that the time to angioembolization is longer than the time to PPP, which may be in part due to the high availability of orthopedic surgeons as compared with that of interventional radiologists [7,12,32], and TAE may be delayed at night or on weekends based on reports of other catheter-based interventions [16,33,34]. In our institution, interventional radiologists and the equipment required for TAE are available 24 h a day, 365 days a year.…”