Cargando…

Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Chou, Chang-Hua, Wu, Yu-Tung, Fu, Chih-Yuan, Liao, Chien-Hung, Wang, Shang-Yu, Bajani, Francesco, Hsieh, Chi-Hsun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567387/
https://www.ncbi.nlm.nih.gov/pubmed/31210779
http://dx.doi.org/10.1186/s13017-019-0248-z
_version_ 1783427065639337984
author Chou, Chang-Hua
Wu, Yu-Tung
Fu, Chih-Yuan
Liao, Chien-Hung
Wang, Shang-Yu
Bajani, Francesco
Hsieh, Chi-Hsun
author_facet Chou, Chang-Hua
Wu, Yu-Tung
Fu, Chih-Yuan
Liao, Chien-Hung
Wang, Shang-Yu
Bajani, Francesco
Hsieh, Chi-Hsun
author_sort Chou, Chang-Hua
collection PubMed
description 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.
format Online
Article
Text
id pubmed-6567387
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-65673872019-06-17 Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture Chou, Chang-Hua Wu, Yu-Tung Fu, Chih-Yuan Liao, Chien-Hung Wang, Shang-Yu Bajani, Francesco Hsieh, Chi-Hsun World J Emerg Surg Research Article 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. BioMed Central 2019-06-13 /pmc/articles/PMC6567387/ /pubmed/31210779 http://dx.doi.org/10.1186/s13017-019-0248-z Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Chou, Chang-Hua
Wu, Yu-Tung
Fu, Chih-Yuan
Liao, Chien-Hung
Wang, Shang-Yu
Bajani, Francesco
Hsieh, Chi-Hsun
Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture
title 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_short 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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567387/
https://www.ncbi.nlm.nih.gov/pubmed/31210779
http://dx.doi.org/10.1186/s13017-019-0248-z
work_keys_str_mv AT chouchanghua hemostasisassoonaspossibletheroleofthetimetoangioembolizationinthemanagementofpelvicfracture
AT wuyutung hemostasisassoonaspossibletheroleofthetimetoangioembolizationinthemanagementofpelvicfracture
AT fuchihyuan hemostasisassoonaspossibletheroleofthetimetoangioembolizationinthemanagementofpelvicfracture
AT liaochienhung hemostasisassoonaspossibletheroleofthetimetoangioembolizationinthemanagementofpelvicfracture
AT wangshangyu hemostasisassoonaspossibletheroleofthetimetoangioembolizationinthemanagementofpelvicfracture
AT bajanifrancesco hemostasisassoonaspossibletheroleofthetimetoangioembolizationinthemanagementofpelvicfracture
AT hsiehchihsun hemostasisassoonaspossibletheroleofthetimetoangioembolizationinthemanagementofpelvicfracture