Door to needle time: has the 2022 ACS VRC interventional radiology readiness standard made a difference?

Abstract

Objective: In 2022, the revised American College of Surgeons (ACS) Verification Review and Consultation (VRC) standards required that all level I and II trauma centers have the resources for an interventional radiology procedure for hemorrhage control to begin within 60 min of request. We sought to investigate the impact of this new standard on time to angiography and patient outcomes in a national database with the hypothesis that the ACS standard would result in quicker time to angiography and improved outcomes.

Methods: This is a retrospective review of all patients included in the 2019, 2021 and 2023 ACS Trauma Quality Programs Participant Use File who underwent urgent angiography for hemorrhage control in Level I and II trauma centers. We compared times and outcomes pre-implementation and post implementation of this standard.

Results: The time to angiography, as measured from emergency department admission, was comparable before and after the implementation of the standard (1.91, 1.86 and 1.91 hours in 2019, 2021 and 2023 respectively, p=0.159). The cohorts also had no significant difference in mortality (15.3, 14.4 vs 14.8%), total length of stay (LOS) (15.6, 15.8 vs 16.1 days) or intensive care unit LOS (8.2, 8.1 vs 8.3 days). There were significant differences with increased blood product transfusion volumes in 2019 (1,386 (2019), 1,228 (2021) and 1,226 mL (2023), p<0.001) as well as increased whole blood use in 2023 (134 (2021) vs 219 mL (2023), p<0.001).

Conclusion: Despite the new VRC standard, there has, to date, been no significant impact on time to angiography or patient outcomes with the possible exception of blood transfusion volumes.

Level of evidence: IV: retrospective study with more than one negative criterion.