出血创伤患者60分钟内血管栓塞：一个有定义差距的有意义的指标

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-04-08 DOI:10.1016/j.amjsurg.2025.116338

Zihan Gao , Nam Yong Cho , Aricia Shen , Nicholas Siena , Troy N. Coaston , Amulya Vadlakonda , Peyman Benharash , Galinos Barmparas , the Academic Trauma Research Consortium (ATRIUM)

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引用次数: 0

摘要

从决定部署介入放射学（IR）到开始使用的时间标准最近从30分钟更改为60分钟，尽管支持证据尚不清楚。我们的目的是确定创伤患者IR时间标准依从性与预后的关系。方法本研究调查了需要血管栓塞的成人创伤患者（≥16岁），按急诊出院后60分钟内（IR60）及之后的IR起始时间进行分层。使用多变量回归来评估IR时间与临床和财务结果的关联。医院水平因素的变异也通过多级模型确定。结果共纳入2793例患者，其中38.3%为IR60。所有风险调整后的结果在两个队列之间相似。此外，IR60比例的显著变化可归因于医院层面的因素。结论IR60和非IR60的临床结果相似，对目前创伤患者血管栓塞时间要求的有效性提出了质疑。

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Angioembolization within 60 minutes for exsanguinating trauma patients: A meaningful metric with a definition gap

Background

Standards on the time from the decision to deploy interventional radiology (IR) to its initiation was recently changed from 30 to 60 min, though supporting evidence remains unclear. We aimed to identify the association of IR timing standard compliance with outcomes among trauma patients.

Methods

This study examined adult trauma patients (≥16 years) requiring angioembolization, stratified by IR initiation within 60 min of emergency department discharge (IR60) and beyond. Multivariable regressions were used to evaluate associations of IR timing with clinical and financial outcomes. Variation attributable to hospital-level factors was also determined using multi-level models.

Results

The study included 2793 patients, of which 38.3 % were IR60. All risk-adjusted outcomes were similar between the two cohorts. Additionally, notable variation in the proportion of IR60 was attributable to hospital-level factors.

Conclusion

Similar clinical outcomes between IR60 and non-IR60 question the validity of the current timing requirement for angioembolization in trauma patients.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.