Table 1 Angiography for Pelvic Fracture Management at Level I Trauma Centers
Questions and Possible Responses | % (n) | n |
|---|---|---|
What agency’s guideline is your trauma center following for pelvic fracture management? | ||
No guideline in place | 28% (11) | 40 |
Eastern Association for the Surgery of Trauma | 23% (9) | |
Hospital developed protocol | 18% (7) | |
Western Trauma Association | 15% (6) | |
Trauma Quality Improvement Program | 8% (3) | |
Advanced Trauma Life Support | 5% (2) | |
Agency not specified | 5% (2) | |
Does your hospital use both angioembolization and pelvic packing for pelvic fracture management? | ||
Yes | 85% (23) | 27 |
No | 15% (4) | |
Angioembolization or Pelvic Packing First? | ||
Angioembolization | 63% (17) | 27 |
Pelvic packing | 37% (10) | |
Does your trauma center have a mobile c-arm? | ||
Yes | 100% (36) | 36 |
No | 0 | |
Indicators for angioembolization | ||
Contrast extravasation | 60% (21) | 35a |
Hemodynamically unstable | 46% (16) | |
Physician’s discretion | 17% (6) | |
Hemodynamically stable | 14% (5) | |
APC, LC, or VS fracture pattern | 9% (3) | |
After pelvic packing | 9% (3) | |
After a circumferential compression device | 9% (3) | |
Pelvic hematoma | 9% (3) | |
Requiring ongoing transfusions | 9% (3) | |
After REBOA | 3% (1) | |
Pseudoaneurysm | 3% (1) | |
When contrast extravasation is absent on computed tomography, but the patient is hemodynamically unstable, is angioembolization considered a treatment option? | ||
Yes | 70% (25) | 36 |
No | 31% (11) | |
What treatment is utilized while waiting for IR to set-up? | ||
Circumferential compression device | 90% (35) | 39a |
Pelvic packing | 64% (25) | |
REBOA | 44% (17) | |
Exploratory laparotomy | 31% (12) | |
Other (massive transfusion protocol) | 3% (1) | |