The role of interventional radiology in trauma

Zealley, Ian; Chakraverty, S.

doi:10.1136/bmj.c497

Cited by 46 publications

(42 citation statements)

References 29 publications

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“…There is a paucity of good quality evidence for use of MDCT and/or embolization in trauma patients who are not completely stable consequently there is currently wide variation in practice with regard to the inclusion of angiography within treatment algorithms, both within the UK and worldwide [4]. There is a need for greater access to MDCT and interventional radiology facilities including sufficient numbers of appropriately trained interventional radiologists and support staff to provide 24 hour cover at trauma centres.…”

Section: Resultsmentioning

confidence: 99%

“…Over the past twenty years there has been a shift towards non-operative management (NOM) for haemodynamically stable patients without evidence of hollow viscus injury and, more recently for selected unstable patients [4]. The availability of rapid CT and the development and refinement of embolisation techniques has widened the indications for NOM in the management of trauma.…”

Section: Introductionmentioning

confidence: 99%

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Angiography and embolisation for solid abdominal organ injury in adults - a current perspective

2010

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Over the past twenty years there has been a shift towards non-operative management (NOM) for haemodynamically stable patients with abdominal trauma. Embolisation can achieve haemostasis and salvage organs without the morbidity of surgery, and the development and refinement of embolisation techniques has widened the indications for NOM in the management of solid organ injury. Advances in computed tomography (CT) technology allow faster scanning times with improved image quality. These improvements mean that whilst surgery is still usually recommended for patients with penetrating injuries, multiple bleeding sites or haemodynamic instability, the indications for NOM are expanding.We present a current perspective on angiography and embolisation in adults with blunt and penetrating abdominal trauma with illustrative examples from our practice including technical advice.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Angiography and embolisation for solid abdominal organ injury in adults - a current perspective

2010

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“…Angiography has emerged as a vital adjunct in the resuscitation of injured patients. 1 As a tool in the armamentarium of trauma care, the role of interventional radiology is no longer purely diagnostic, but instead has evolved into a predominantly therapeutic endeavour. 2 Modern trauma care relies heavily on nonoperative, emergent percutaneous techniques in the management of injured patients with substantial hemorrhage, particularly in patients with splenic, pelvic and hepatic injuries.…”

Section: Resultsmentioning

confidence: 99%

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Smith

Ouellet

Niven

et al. 2013

CJS

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RESEARCH • RECHERCHETimeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?Background: Modern trauma care relies heavily on nonoperative, emergent percutaneous procedures, particularly in patients with splenic, pelvic and hepatic injuries. Unfortunately, specific quality measures (e.g., arrival to angiography times) have not been widely discussed. Our objective was to evaluate the time interval from arrival to initiation of emergent percutaneous procedures in severely injured patients.Methods: All severely injured trauma patients (injury severity score [ISS] > 12) presenting to a level 1 trauma centre (2007)(2008)(2009)(2010) were analyzed with standard statistical methodology.Results: Among 60 severely injured patients (mean ISS 31, hypotension 18%, mortality 12%), the median time interval to the initiation of an angiographic procedure was 270 minutes. Of the procedures performed, 85% were therapeutic embolizations and 15% were diagnostic procedures. Splenic (median time 243 min, range 32-801 min) and pelvic (median time 278 min, range 153-466 min) embolizations accounted for 43% and 25% of procedures, respectively. The median embolization procedure duration for the spleen was 28 (range 15-153) minutes compared with 59 (range 34-171) minutes for the pelvis. Nearly 22% of patients required both an emergent percutaneous and subsequent operative procedure. Percutaneous therapy typically preceded open operative explorations. Conclusion:The time interval from arrival at the trauma centre to emergent percutaneous procedures varied widely. Improved processes emphasizing patient transition from the trauma bay to the angiography suite are essential. Discussion regarding the appropriate time to angiography is needed so this marker can be used as a quality outcome measure for all level 1 trauma centres. Contexte :De nos jours, en traumatologie, les soins reposent largement sur des interventions non chirurgicales percutanées d'extrême urgence, particulièrement chez les patients blessés à la rate, au bassin et au foie. Malheureusement, les indices de qualité spé-cifiques (p. ex., temps écoulé entre l'arrivée et l'angiographie) n'ont pas fait l'objet de discussions approfondies. Notre objectif était de mesurer le temps écoulé entre l'arrivée et l'instauration des interventions percutanées d'extrême urgence chez les grands blessés. Méthodes

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“…The radiologist checks the initial images 1,13,32 in order to identify possible lifethreatening injuries requiring immediate attention, and investigates the presence of active bleeding and its origin. 51 Among other advantages, this approach reduces the need for organ resection and nontherapeutic laparotomies, avoids the stress of surgery, and lessens the transfusion needs and costs. Based on these objective data, we then plan management: observation, admission to the ICU, endovascular intervention or surgery.…”

Section: Ideal Location Equipment and Structure Of The Computed Tomomentioning

confidence: 99%

Radiology and imaging techniques in severe trauma

Martín

Gracia

Vega

et al. 2015

Medicina Intensiva (English Edition)

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The role of interventional radiology in trauma

Cited by 46 publications

References 29 publications

Angiography and embolisation for solid abdominal organ injury in adults - a current perspective

Angiography and embolisation for solid abdominal organ injury in adults - a current perspective

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Radiology and imaging techniques in severe trauma

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