Are we delivering two standards of care for pelvic trauma? Availability of angioembolization after hours and on weekends increases time to therapeutic intervention

Diane A. Schwartz, Michael Medina, Bryan A. Cotton, Elaheh Rahbar, Charles E. Wade, Alan M. Cohen, Angela M. Beeler, Andrew R. Burgess, John B. Holcomb

Research output: Contribution to journalArticle

Abstract

BACKGROUND: We hypothesized that patients with pelvic fractures and hemorrhage admitted during daytime hours were undergoing interventional radiology (IR) earlier than those admitted at night and on weekends, thereby establishing two standards of time to hemorrhage control. METHODS: The trauma registry (January 2008 to December 2011) was reviewed for patients admitted with pelvic fractures, hemorrhagic shock, and transfusion of at least 1 U of blood. The control group (DAY) was admitted from 7:30 AM to 5:30 PM Monday to Friday, while the study group (after hours [AHR]) was admitted from 5:30 PM to 7:30 AM, on weekends or holidays. RESULTS: A total of 191 patients met the criteria (45 DAY, 146 AHR); 103 died less than 24 hours and without undergoing IR (29% DAY group vs. 62% AHR, p > 0.001). Sixteen patients (all in AHR group) died while awaiting IR (p = 0.032). Eighty-eight patients (32DAY, 56 AHR) survived to receive IR.Among these, the AHR groupwere younger (median, 30 years vs. 54 years; p = 0.007), more tachycardic (median pulse, 119 beats/min vs. 90 beats/min; p = 0.001), and hadmore profound shock (median base,j10 vs. j6; p = 0.006) on arrival. Time fromadmission to IR(median, 301minutes vs. 193minutes; p > 0.001) and computed tomographic scan to IR (176minutes vs. 87 minutes, p = 0.011) were longer in theAHR group. Therewas no difference in the 30-day mortality by univariate analysis. However, after controlling for age, arrival physiology, injury severity, and degree of shock, the AHR group had a 94% increased risk of mortality. CONCLUSION: The current study demonstrated that patients admitted at night and on weekends have a significant increase in time to angioembolization compared with those arriving during the daytime and during the week. Multivariate regression noted that AHR management was associated with an almost 100% increase in mortality. While this is a single-center study and retrospective in nature, it suggests that we are currently delivering two standards of care for pelvic trauma, depending on the day and time of admission.

Original languageEnglish (US)
Pages (from-to)134-139
Number of pages6
JournalThe journal of trauma and acute care surgery
Volume76
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

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Interventional Radiology
Standard of Care
Wounds and Injuries
Mortality
Shock
Therapeutics
Hemorrhage
Holidays
Hemorrhagic Shock
Registries
Retrospective Studies
Control Groups

Keywords

  • Angiography
  • Embolization
  • Fracture
  • Pelvic
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Are we delivering two standards of care for pelvic trauma? Availability of angioembolization after hours and on weekends increases time to therapeutic intervention. / Schwartz, Diane A.; Medina, Michael; Cotton, Bryan A.; Rahbar, Elaheh; Wade, Charles E.; Cohen, Alan M.; Beeler, Angela M.; Burgess, Andrew R.; Holcomb, John B.

In: The journal of trauma and acute care surgery, Vol. 76, No. 1, 01.2014, p. 134-139.

Research output: Contribution to journalArticle

Schwartz, Diane A. ; Medina, Michael ; Cotton, Bryan A. ; Rahbar, Elaheh ; Wade, Charles E. ; Cohen, Alan M. ; Beeler, Angela M. ; Burgess, Andrew R. ; Holcomb, John B. / Are we delivering two standards of care for pelvic trauma? Availability of angioembolization after hours and on weekends increases time to therapeutic intervention. In: The journal of trauma and acute care surgery. 2014 ; Vol. 76, No. 1. pp. 134-139.
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abstract = "BACKGROUND: We hypothesized that patients with pelvic fractures and hemorrhage admitted during daytime hours were undergoing interventional radiology (IR) earlier than those admitted at night and on weekends, thereby establishing two standards of time to hemorrhage control. METHODS: The trauma registry (January 2008 to December 2011) was reviewed for patients admitted with pelvic fractures, hemorrhagic shock, and transfusion of at least 1 U of blood. The control group (DAY) was admitted from 7:30 AM to 5:30 PM Monday to Friday, while the study group (after hours [AHR]) was admitted from 5:30 PM to 7:30 AM, on weekends or holidays. RESULTS: A total of 191 patients met the criteria (45 DAY, 146 AHR); 103 died less than 24 hours and without undergoing IR (29{\%} DAY group vs. 62{\%} AHR, p > 0.001). Sixteen patients (all in AHR group) died while awaiting IR (p = 0.032). Eighty-eight patients (32DAY, 56 AHR) survived to receive IR.Among these, the AHR groupwere younger (median, 30 years vs. 54 years; p = 0.007), more tachycardic (median pulse, 119 beats/min vs. 90 beats/min; p = 0.001), and hadmore profound shock (median base,j10 vs. j6; p = 0.006) on arrival. Time fromadmission to IR(median, 301minutes vs. 193minutes; p > 0.001) and computed tomographic scan to IR (176minutes vs. 87 minutes, p = 0.011) were longer in theAHR group. Therewas no difference in the 30-day mortality by univariate analysis. However, after controlling for age, arrival physiology, injury severity, and degree of shock, the AHR group had a 94{\%} increased risk of mortality. CONCLUSION: The current study demonstrated that patients admitted at night and on weekends have a significant increase in time to angioembolization compared with those arriving during the daytime and during the week. Multivariate regression noted that AHR management was associated with an almost 100{\%} increase in mortality. While this is a single-center study and retrospective in nature, it suggests that we are currently delivering two standards of care for pelvic trauma, depending on the day and time of admission.",
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T1 - Are we delivering two standards of care for pelvic trauma? Availability of angioembolization after hours and on weekends increases time to therapeutic intervention

AU - Schwartz, Diane A.

AU - Medina, Michael

AU - Cotton, Bryan A.

AU - Rahbar, Elaheh

AU - Wade, Charles E.

AU - Cohen, Alan M.

AU - Beeler, Angela M.

AU - Burgess, Andrew R.

AU - Holcomb, John B.

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N2 - BACKGROUND: We hypothesized that patients with pelvic fractures and hemorrhage admitted during daytime hours were undergoing interventional radiology (IR) earlier than those admitted at night and on weekends, thereby establishing two standards of time to hemorrhage control. METHODS: The trauma registry (January 2008 to December 2011) was reviewed for patients admitted with pelvic fractures, hemorrhagic shock, and transfusion of at least 1 U of blood. The control group (DAY) was admitted from 7:30 AM to 5:30 PM Monday to Friday, while the study group (after hours [AHR]) was admitted from 5:30 PM to 7:30 AM, on weekends or holidays. RESULTS: A total of 191 patients met the criteria (45 DAY, 146 AHR); 103 died less than 24 hours and without undergoing IR (29% DAY group vs. 62% AHR, p > 0.001). Sixteen patients (all in AHR group) died while awaiting IR (p = 0.032). Eighty-eight patients (32DAY, 56 AHR) survived to receive IR.Among these, the AHR groupwere younger (median, 30 years vs. 54 years; p = 0.007), more tachycardic (median pulse, 119 beats/min vs. 90 beats/min; p = 0.001), and hadmore profound shock (median base,j10 vs. j6; p = 0.006) on arrival. Time fromadmission to IR(median, 301minutes vs. 193minutes; p > 0.001) and computed tomographic scan to IR (176minutes vs. 87 minutes, p = 0.011) were longer in theAHR group. Therewas no difference in the 30-day mortality by univariate analysis. However, after controlling for age, arrival physiology, injury severity, and degree of shock, the AHR group had a 94% increased risk of mortality. CONCLUSION: The current study demonstrated that patients admitted at night and on weekends have a significant increase in time to angioembolization compared with those arriving during the daytime and during the week. Multivariate regression noted that AHR management was associated with an almost 100% increase in mortality. While this is a single-center study and retrospective in nature, it suggests that we are currently delivering two standards of care for pelvic trauma, depending on the day and time of admission.

AB - BACKGROUND: We hypothesized that patients with pelvic fractures and hemorrhage admitted during daytime hours were undergoing interventional radiology (IR) earlier than those admitted at night and on weekends, thereby establishing two standards of time to hemorrhage control. METHODS: The trauma registry (January 2008 to December 2011) was reviewed for patients admitted with pelvic fractures, hemorrhagic shock, and transfusion of at least 1 U of blood. The control group (DAY) was admitted from 7:30 AM to 5:30 PM Monday to Friday, while the study group (after hours [AHR]) was admitted from 5:30 PM to 7:30 AM, on weekends or holidays. RESULTS: A total of 191 patients met the criteria (45 DAY, 146 AHR); 103 died less than 24 hours and without undergoing IR (29% DAY group vs. 62% AHR, p > 0.001). Sixteen patients (all in AHR group) died while awaiting IR (p = 0.032). Eighty-eight patients (32DAY, 56 AHR) survived to receive IR.Among these, the AHR groupwere younger (median, 30 years vs. 54 years; p = 0.007), more tachycardic (median pulse, 119 beats/min vs. 90 beats/min; p = 0.001), and hadmore profound shock (median base,j10 vs. j6; p = 0.006) on arrival. Time fromadmission to IR(median, 301minutes vs. 193minutes; p > 0.001) and computed tomographic scan to IR (176minutes vs. 87 minutes, p = 0.011) were longer in theAHR group. Therewas no difference in the 30-day mortality by univariate analysis. However, after controlling for age, arrival physiology, injury severity, and degree of shock, the AHR group had a 94% increased risk of mortality. CONCLUSION: The current study demonstrated that patients admitted at night and on weekends have a significant increase in time to angioembolization compared with those arriving during the daytime and during the week. Multivariate regression noted that AHR management was associated with an almost 100% increase in mortality. While this is a single-center study and retrospective in nature, it suggests that we are currently delivering two standards of care for pelvic trauma, depending on the day and time of admission.

KW - Angiography

KW - Embolization

KW - Fracture

KW - Pelvic

KW - Trauma

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