title: Impact of mobile angiography in the emergency department for controlling pelvic fracture hemorrhage with hemodynamic instability.
abstract: OBJECTIVE
  Rapid trauma evaluation and intervention without time delay are considered integral to time-efficient management of trauma patients, particularly for those with hemodynamic instability. This study examined the impact of immediate availability of mobile angiography with digital subtraction angiography technology in the emergency department (ED) for hemodynamically unstable multiple trauma patients with pelvic injury.
  
  
  METHODS
  This retrospective review examined a cohort of all blunt trauma patients with pelvic injury who underwent transcatheter arterial embolization (TAE) using mobile angiography by trauma surgeons in the ED. This system was set up on a 24-hour basis with full-time trauma surgeons available in-hospital. Data collected included clinical characteristics, injury severity, resuscitation intervals from admission through to completion of hemostasis, metabolic factors (pH and core body temperature), mortality, and TAE-related complications.
  
  
  RESULTS
  Subjects comprised 29 patients (hemodynamically stable group, n = 17; hemodynamically unstable group, n = 12) with a median age of 36 years (interquartile range [IQR], 29-53 years). Mean shock index, injury severity score, and trauma and injury severity score were 1.1 +/- 0.5, 32 +/- 12, and 0.79 +/- 0.27, respectively. Median intervals from ED arrival to diagnosis and from diagnosis to starting TAE were 66 minutes (IQR, 42-80 minutes) and 30 minutes (IQR, 25-37 minutes), respectively. Median interval from diagnosis to completion of TAE was 107 minutes (IQR, 93-130 minutes). Physical and anatomic injury statuses were more severe in the hemodynamically unstable group than in the hemodynamically stable group. However, intervals from diagnosis to starting TAE and from diagnosis to completion of hemostasis did not differ significantly between groups. No exacerbations of metabolic factors during resuscitation were identified. Pelvic injury related mortality was 17% and no TAE-related complications were encountered.
  
  
  CONCLUSIONS
  Immediate availability of mobile angiography in the ED seems safe and effective for hemodynamically unstable trauma patients with pelvic injury and results in a rapid improvement in resuscitation intervals without leaving the ED. An adequately randomized controlled trial of mobile angiography in this subset of patients, who would seem to derive the most benefit from mobile angiography, would be ideal.
authors.affiliation: Department of Emergency and Critical Care Medicine, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. junya99@tokyo-med.ac.jp
authors.forename: Junya
authors.initials: J
authors.lastname: Morozumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Homma
authors.forename: Shoichi
authors.initials: S
authors.lastname: Ohta
authors.forename: Mariko
authors.initials: M
authors.lastname: Noda
authors.forename: Jun
authors.initials: J
authors.lastname: Oda
authors.forename: Shiro
authors.initials: S
authors.lastname: Mishima
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Yukioka
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D004621:Embolization, Therapeutic; D004636:Emergency Service, Hospital; D050723:Fractures, Bone / Q000150:complications*; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D019095:Point-of-Care Systems; D015641:Radiography, Interventional; D012771:Shock, Hemorrhagic / Q000503:physiopathology