Clinical Scorecard: Essential Insights on Trauma Teams and the Contribution of Interventional Radiology: Guidelines from the Cardiovascular and Interventional Radiological Society of Europe

At a Glance

Key Highlights

• Interventional Radiologists should be integrated into trauma teams with 24/7 availability in Level I centers and structured access in Level II–III centers.
• Whole-body contrast-enhanced CT is recommended in stable or stabilizable trauma patients to guide timely IR interventions.
• Standardized embolization protocols and rapid access to embolic materials and REBOA are essential for effective trauma IR management.

Guideline-Based Recommendations

Diagnosis

• Perform whole-body contrast-enhanced CT with plain, arterial, and portal venous phases in stable or stabilizable trauma patients.
• Use imaging findings such as active arterial extravasation or pseudoaneurysm to guide prompt embolization.
• Employ FAST ultrasound and conventional radiography as adjuncts, but prioritize multislice CT for polytrauma evaluation.

Management

• Integrate Interventional Radiologists into trauma team activation and decision-making processes.
• Ensure 24/7 IR availability in Level I centers; establish structured IR access or transfer protocols in Level II and III centers.
• Locate angiosuites near trauma bays to minimize treatment delays.
• Standardize embolization protocols and maintain rapid access to coils, plugs, liquid agents, stent-grafts, and REBOA devices.
• Provide IR-specific trauma training and dedicated equipment kits.

Monitoring & Follow-up

• Implement multidisciplinary trauma team collaboration including emergency physicians, diagnostic and interventional radiologists, surgeons, anesthesiologists, and intensive care specialists.
• Use hybrid emergency rooms to facilitate seamless CT-to-IR workflows and continuous patient monitoring.

Risks

• Delays in IR activation or lack of 24/7 IR availability can increase mortality from uncontrolled hemorrhage.
• Inadequate embolization protocols or material availability may compromise hemorrhage control and organ preservation.
• Insufficient trauma team coordination can lead to suboptimal patient outcomes.

Patient & Prescribing Data

Trauma patients with non-compressible bleeding and solid organ injuries requiring minimally invasive hemorrhage control

Early IR involvement and prompt embolization guided by contrast-enhanced CT improve hemorrhage control and reduce need for open surgery.

Clinical Best Practices

• Ensure 24/7 availability of Interventional Radiology in Level I trauma centers and structured access in Level II–III centers.
• Perform whole-body contrast-enhanced CT promptly in stable or stabilizable trauma patients to identify bleeding sources.
• Develop and implement standardized embolization protocols with ready access to a full range of embolic materials and REBOA.
• Locate angiosuites adjacent to trauma bays to reduce treatment delays.
• Foster multidisciplinary trauma teams including IR, surgery, emergency medicine, anesthesiology, and intensive care.
• Utilize hybrid emergency rooms to integrate imaging, intervention, and surgery in a single resuscitation space.
• Provide ongoing IR-specific trauma training and maintain dedicated trauma IR equipment kits.

References

• CIRSE quality improvement guidelines for endovascular treatment of traumatic hemorrhage (2012)
• World Society of Emergency Surgery (WSES) and AAST grading system
• Kinoshita et al. Hybrid emergency room concept in trauma care