Variability in pelvic packing practices for hemodynamically unstable pelvic fractures at US level 1 trauma centers
العنوان: | Variability in pelvic packing practices for hemodynamically unstable pelvic fractures at US level 1 trauma centers |
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المؤلفون: | Matthew M. Carrick, Benoit Blondeau, Stephanie Jarvis, Rick Meinig, Alessandro Orlando, David Bar-Or, Gina M. Berg, Nimesh S. A. Patel, Allen Tanner, Kaysie L. Banton |
المصدر: | Patient Safety in Surgery, Vol 13, Iss 1, Pp 1-10 (2019) Patient Safety in Surgery |
بيانات النشر: | BMC, 2019. |
سنة النشر: | 2019 |
مصطلحات موضوعية: | Infection risk, medicine.medical_specialty, Resuscitation, Pelvic fracture management, lcsh:Surgery, Trauma, 03 medical and health sciences, Trauma medical directors, 0302 clinical medicine, medicine, Orthopedics and Sports Medicine, 030212 general & internal medicine, Pelvic packing, Survey, business.industry, Research, Trauma center, 030208 emergency & critical care medicine, lcsh:RD1-811, Surgery, Anesthesiology and Pain Medicine, Treatment modality, Emergency medicine, Respondent, Level 1 trauma centers, business |
الوصف: | Background Mortality from hemodynamically unstable pelvic fractures remains high. Guidelines offer varying care approaches including the use of pelvic packing (PP), which was recently adopted for potential control of bleeding for this condition. However, the implementation of PP is uncertain as the debate on the optimal resuscitation strategy, angioembolization or PP continues. The study was designed to assess current practices among level 1 trauma centers in the US in regard to PP treatment for hemodynamically unstable pelvic fractures. Methods A cross-sectional survey was created to assess when to apply PP, application approach, and the respondent’s anecdotal perception on safety and effectiveness. Trauma Medical Directors at 158 US level 1 trauma centers were sent biweekly email invitations for 3 months. Participants were allowed to skip questions for any reason. The study hypothesis was that PP practices vary by US census bureau region, annual trauma admissions, and length of time in years since each trauma center received their respective level 1 trauma center designation. Results Twenty-five percent (40/158) of trauma medical directors participated and 75% (118/158) of the trauma medical directors did not participate. Of those who took the survey, 36/40 (90%) completed the survey and 4/40 (10%) partially completed the survey. Only 36 trauma medical directors responded on their perception of safety and effectiveness; 72% (26/36) of participants perceived PP as safe, whereas only a third (12/36) of participants perceived PP as effective. There were 25 trauma medical directors who provided the sequence of treatment modalities utilized at their level 1 trauma center, 76% (19/25) of participants reported that PP is utilized as the third or fourth priority. None of the participating level 1 trauma centers reported a preference towards utilization of PP as the first priority treatment. Half of the participants reported a preference towards applying PP only as a last resort to control hemorrhage. Northeastern and Western level 1 trauma centers were significantly more likely than Midwestern and Southern level 1 trauma centers to have reported application of PP to all hemodynamically unstable patients (p = 0.05). Midwestern, Southern, and Western level 1 trauma centers were significantly more likely to have perceived PP as safe than Northeastern level 1 trauma centers (p = 0.04). All low-volume and 38% high-volume level 1 trauma centers perceived PP to increase infection risks, (p = 0.03). We observed no association between the length of time each trauma center was designated a level 1 trauma center, and all participant responses. Conclusion Controversy and varying anecdotal perception regarding safety and effectiveness of PP prevails among trauma medical directors at level 1 trauma centers in the US. |
اللغة: | English |
تدمد: | 1754-9493 |
URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::87779ed8891fcd3e063dff5bbf3afdb1 http://link.springer.com/article/10.1186/s13037-019-0183-7 |
حقوق: | OPEN |
رقم الأكسشن: | edsair.doi.dedup.....87779ed8891fcd3e063dff5bbf3afdb1 |
قاعدة البيانات: | OpenAIRE |
تدمد: | 17549493 |
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