Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture
Abstract Introduction While transcatheter arterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, delayed TAE may increase mortality risk. The purpose of the current study was to determine how time to TAE affects outcomes in patients with pelvic...
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doaj-77e02cf2288243a6b20fb1da70a76e202020-11-25T03:20:47ZengBMCWorld Journal of Emergency Surgery1749-79222019-06-011411810.1186/s13017-019-0248-zHemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fractureChang-Hua Chou0Yu-Tung Wu1Chih-Yuan Fu2Chien-Hung Liao3Shang-Yu Wang4Francesco Bajani5Chi-Hsun Hsieh6Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung UniversityDepartment of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung UniversityDepartment of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung UniversityDepartment of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung UniversityDepartment of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung UniversityDepartment of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung UniversityDepartment of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung UniversityAbstract Introduction While transcatheter arterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, delayed TAE may increase mortality risk. The purpose of the current study was to determine how time to TAE affects outcomes in patients with pelvic fracture in the emergency department. Methods From January 2014 to December 2016, the trauma registry and medical records of patients with pelvic fracture who underwent TAE were retrospectively reviewed. The relationship between the time to TAE and patient outcomes was evaluated. The characteristics of surviving and deceased patients were also compared to search for prognostic factors affecting survival. Results Eighty-four patients were enrolled in the current study. Among patients with pelvic fracture who underwent TAE, the overall mortality rate was 16.7%. There were positive relationships between the time to TAE and the requirement for blood transfusion and between the time to TAE and intensive care unit (ICU) length of stay (LOS). Nonsurviving patients were significantly older (57.4 ± 23.3 vs. 42.7 ± 19.3 years old, p = 0.014) and had higher injury severity scores (ISSs) (36.4 ± 11.9 vs. 23.9 ± 10.9, p < 0.001) than were observed in surviving patients. There was no significant difference in the time to TAE between nonsurviving and surviving patients (76.9 ± 47.9 vs. 59.0 ± 29.3 min, p = 0.068). The multivariate logistic regression analysis showed that ISS and age served as independent risk factors for mortality. Every one unit increase in ISS or age resulted in a 1.154- or 1.140-fold increase in mortality, respectively (p = 0.033 and 0.005, respectively). However, the time to TAE serves as an independent factor for ICU LOS (p = 0.015). Conclusion In pelvic fracture patients who require TAE for hemostasis, longer time to TAE may cause harm. An early hemorrhage control is suggested.http://link.springer.com/article/10.1186/s13017-019-0248-zPelvic fractureTAELength of stayTimingAngioembolization |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Chang-Hua Chou Yu-Tung Wu Chih-Yuan Fu Chien-Hung Liao Shang-Yu Wang Francesco Bajani Chi-Hsun Hsieh |
spellingShingle |
Chang-Hua Chou Yu-Tung Wu Chih-Yuan Fu Chien-Hung Liao Shang-Yu Wang Francesco Bajani Chi-Hsun Hsieh Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture World Journal of Emergency Surgery Pelvic fracture TAE Length of stay Timing Angioembolization |
author_facet |
Chang-Hua Chou Yu-Tung Wu Chih-Yuan Fu Chien-Hung Liao Shang-Yu Wang Francesco Bajani Chi-Hsun Hsieh |
author_sort |
Chang-Hua Chou |
title |
Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture |
title_short |
Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture |
title_full |
Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture |
title_fullStr |
Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture |
title_full_unstemmed |
Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture |
title_sort |
hemostasis as soon as possible? the role of the time to angioembolization in the management of pelvic fracture |
publisher |
BMC |
series |
World Journal of Emergency Surgery |
issn |
1749-7922 |
publishDate |
2019-06-01 |
description |
Abstract Introduction While transcatheter arterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, delayed TAE may increase mortality risk. The purpose of the current study was to determine how time to TAE affects outcomes in patients with pelvic fracture in the emergency department. Methods From January 2014 to December 2016, the trauma registry and medical records of patients with pelvic fracture who underwent TAE were retrospectively reviewed. The relationship between the time to TAE and patient outcomes was evaluated. The characteristics of surviving and deceased patients were also compared to search for prognostic factors affecting survival. Results Eighty-four patients were enrolled in the current study. Among patients with pelvic fracture who underwent TAE, the overall mortality rate was 16.7%. There were positive relationships between the time to TAE and the requirement for blood transfusion and between the time to TAE and intensive care unit (ICU) length of stay (LOS). Nonsurviving patients were significantly older (57.4 ± 23.3 vs. 42.7 ± 19.3 years old, p = 0.014) and had higher injury severity scores (ISSs) (36.4 ± 11.9 vs. 23.9 ± 10.9, p < 0.001) than were observed in surviving patients. There was no significant difference in the time to TAE between nonsurviving and surviving patients (76.9 ± 47.9 vs. 59.0 ± 29.3 min, p = 0.068). The multivariate logistic regression analysis showed that ISS and age served as independent risk factors for mortality. Every one unit increase in ISS or age resulted in a 1.154- or 1.140-fold increase in mortality, respectively (p = 0.033 and 0.005, respectively). However, the time to TAE serves as an independent factor for ICU LOS (p = 0.015). Conclusion In pelvic fracture patients who require TAE for hemostasis, longer time to TAE may cause harm. An early hemorrhage control is suggested. |
topic |
Pelvic fracture TAE Length of stay Timing Angioembolization |
url |
http://link.springer.com/article/10.1186/s13017-019-0248-z |
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