Resuscitative Endovascular Balloon Occlusion of the Aorta: Assessing Need in an Urban Trauma Center.
Adult
Aorta
/ surgery
Balloon Occlusion
/ statistics & numerical data
Endovascular Procedures
/ statistics & numerical data
Health Services Needs and Demand
Hemorrhage
/ epidemiology
Hemostatic Techniques
/ statistics & numerical data
Hospitals, Urban
/ organization & administration
Humans
Male
Middle Aged
Needs Assessment
/ statistics & numerical data
Resuscitation
/ methods
Retrospective Studies
Torso
Trauma Centers
/ organization & administration
Young Adult
Hemorrhage control
Needs assessment
REBOA
Resuscitative endovascular balloon occlusion
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
12
02
2018
revised:
07
07
2018
accepted:
14
08
2018
entrez:
4
12
2018
pubmed:
7
12
2018
medline:
14
11
2019
Statut:
ppublish
Résumé
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a bridge to definitive hemostasis in select patients with noncompressible torso hemorrhage. The number of patients who might benefit from this procedure, however, remains incompletely defined. We hypothesized that we could quantify the number of patients presenting to our center over a 2-year period who may have benefited from REBOA. All patients presenting to our trauma center from 2014 to 2015 were included. Potential REBOA patients were identified based on anatomic injuries. We used ICD-9 codes to identify REBOA-amenable injury patterns and physiology. We excluded patients with injuries contraindicating REBOA. We then used chart review by two REBOA-experienced independent reviewers to assess each potential REBOA candidate, evaluate the accuracy of our algorithm, and to identify a cohort of confirmed REBOA candidates. Four thousand eight hundred eighteen patients were included of which 666 had injuries potentially amenable to REBOA. Three hundred thirty-five patients were hemodynamically unstable, and 309 patients had contraindications to REBOA. Sixty-four patients had both injury patterns and physiology amenable to REBOA with no contraindications, and these patients were identified as potential REBOA candidates. Of these, detailed independent two physician chart review identified 29 patients (45%) as confirmed REBOA candidates (interrater reliability kappa = 0.94, P < 0.001). Our database query identified patients with indications for REBOA but overestimated the number of REBOA candidates. To accurately quantify the REBOA candidate population at a given center, an algorithm to identify potential patients should be combined with chart review. Therapeutic study, level V.
Sections du résumé
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a bridge to definitive hemostasis in select patients with noncompressible torso hemorrhage. The number of patients who might benefit from this procedure, however, remains incompletely defined. We hypothesized that we could quantify the number of patients presenting to our center over a 2-year period who may have benefited from REBOA.
METHODS
All patients presenting to our trauma center from 2014 to 2015 were included. Potential REBOA patients were identified based on anatomic injuries. We used ICD-9 codes to identify REBOA-amenable injury patterns and physiology. We excluded patients with injuries contraindicating REBOA. We then used chart review by two REBOA-experienced independent reviewers to assess each potential REBOA candidate, evaluate the accuracy of our algorithm, and to identify a cohort of confirmed REBOA candidates.
RESULTS
Four thousand eight hundred eighteen patients were included of which 666 had injuries potentially amenable to REBOA. Three hundred thirty-five patients were hemodynamically unstable, and 309 patients had contraindications to REBOA. Sixty-four patients had both injury patterns and physiology amenable to REBOA with no contraindications, and these patients were identified as potential REBOA candidates. Of these, detailed independent two physician chart review identified 29 patients (45%) as confirmed REBOA candidates (interrater reliability kappa = 0.94, P < 0.001).
CONCLUSIONS
Our database query identified patients with indications for REBOA but overestimated the number of REBOA candidates. To accurately quantify the REBOA candidate population at a given center, an algorithm to identify potential patients should be combined with chart review.
STUDY TYPE
Therapeutic study, level V.
Identifiants
pubmed: 30502280
pii: S0022-4804(18)30600-0
doi: 10.1016/j.jss.2018.08.031
pmc: PMC6713903
mid: NIHMS1044538
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
413-419Subventions
Organisme : NHLBI NIH HHS
ID : K08 HL131995
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
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