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CODE-IR: ACCELERATING INTERVENTIONAL RADIOLOGY ACTIVATION IN TRAUMATIC HEMORRHAGE IMPACTS TIME TO INTERVENTION AND MORTALITY
Deborah Dele-Oni DO, MA1, Anne K Buck MS, PhD2, Khuaten Maneeb de Macebo MD1, Curtis HonShideler MD1, David Guez MD1, Megan Janeway MD1, Sheina Theodore MD1, 1Boston University Medical Center, 2Boston University School of Public Health
Background: Interventional radiology (IR) is increasingly important in the management of traumatic hemorrhage, but delays in activation may worsen outcomes. The Code-IR early activation protocol was developed to expedite IR involvement. We evaluated its impact on time to intervention and mortality. Methods: We performed a retrospective cohort study of adult trauma patients undergoing IR intervention for hemorrhage at a Level I trauma center (July 2014–July 2024). Patients with IR procedures performed >6 hours after arrival or for non-hemorrhagic indications were excluded. Patients were grouped into standard IR activation (2014–2019) or Code-IR activation (February 2019–2024). The primary outcome was time from hospital arrival to IR needle stick. Secondary outcomes included hospital length of stay (LOS), ICU LOS, and 30-day mortality. Multivariable regression adjusted for age, sex, and Injury Severity Score (ISS). Results: Among 115 patients, 59 (51.3%) underwent Code-IR activation. Median time to intervention was significantly shorter with Code-IR than standard activation (2.98 vs. 3.40 hours; p=0.025). After adjustment, Code-IR remained independently associated with reduced time to intervention (adjusted effect estimate 0.43, 95% CI 0.06–0.80; p=0.029). Code-IR was associated with a trend toward lower 30-day mortality (aOR 0.23, 95% CI 0.02–0.48; p=0.073). Hospital LOS and ICU LOS did not differ significantly. Female sex was independently associated with shorter time to intervention (p=0.005) and lower 30-day mortality (p=0.017).] Conclusions: Code-IR implementation significantly reduced time to IR intervention and demonstrated a trend toward improved survival. Early activation protocols enhance efficiency and improve outcomes in trauma-related hemorrhage.
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