{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T03:02:04Z","timestamp":1784602924360,"version":"3.55.0"},"reference-count":11,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2026,6,2]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>In 2022, the revised American College of Surgeons (ACS) Verification Review and Consultation (VRC) standards required that all level I and II trauma centers have the resources for an interventional radiology procedure for hemorrhage control to begin within 60\u2009min of request. We sought to investigate the impact of this new standard on time to angiography and patient outcomes in a national database with the hypothesis that the ACS standard would result in quicker time to angiography and improved outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective review of all patients included in the 2019, 2021 and 2023 ACS Trauma Quality Programs Participant Use File who underwent urgent angiography for hemorrhage control in Level I and II trauma centers. We compared times and outcomes pre-implementation and post implementation of this standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The time to angiography, as measured from emergency department admission, was comparable before and after the implementation of the standard (1.91, 1.86 and 1.91\u2009hours in 2019, 2021 and 2023 respectively, p=0.159). The cohorts also had no significant difference in mortality (15.3, 14.4 vs 14.8%), total length of stay (LOS) (15.6, 15.8 vs 16.1\u2009days) or intensive care unit LOS (8.2, 8.1 vs 8.3\u2009days). There were significant differences with increased blood product transfusion volumes in 2019 (1,386 (2019), 1,228 (2021) and 1,226\u2009mL (2023), p&lt;0.001) as well as increased whole blood use in 2023 (134 (2021) vs 219\u2009mL (2023), p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite the new VRC standard, there has, to date, been no significant impact on time to angiography or patient outcomes with the possible exception of blood transfusion volumes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>IV: retrospective study with more than one negative criterion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tsaco-2025-002186","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:39:50Z","timestamp":1783345190000},"page":"e002186","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Door to needle time: has the 2022 ACS VRC interventional radiology readiness standard made a difference?"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3853-5425","authenticated-orcid":false,"given":"Adrian A","family":"Maung","sequence":"first","affiliation":[{"name":"Surgery, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christofer","family":"Anderson","sequence":"additional","affiliation":[{"name":"Surgery, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew Tsuei","family":"Maung","sequence":"additional","affiliation":[{"name":"Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Jones","sequence":"additional","affiliation":[{"name":"Surgery, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane R","family":"Cowan","sequence":"additional","affiliation":[{"name":"Surgery, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5660-5293","authenticated-orcid":false,"given":"Kimberly A","family":"Davis","sequence":"additional","affiliation":[{"name":"Surgery, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"2026070606200703000_11.3.e002186.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61728-0"},{"key":"2026070606200703000_11.3.e002186.2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1055\/s-2004-831401","article-title":"Transcatheter Arterial Embolization in the Trauma Patient: A Review","volume":"21","author":"Bauer","year":"2004","journal-title":"Semin intervent Radiol"},{"key":"2026070606200703000_11.3.e002186.3","unstructured":"American College of Surgeons . Committee on trauma. resources for optimal care of the injured patient. Chicago, Ill: American College of Surgeons, Committee on Trauma, 2014."},{"key":"2026070606200703000_11.3.e002186.4","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.jvir.2019.11.012","article-title":"Society of Interventional Radiology Position Statement on Endovascular Intervention for Trauma","volume":"31","author":"Padia","year":"2020","journal-title":"J Vasc Interv Radiol"},{"key":"2026070606200703000_11.3.e002186.5","unstructured":"American College of Surgeons . Committee on trauma. resources for optimal care of the injured patient: 2022 standards. Chicago, Ill: American College of Surgeons, Committee on Trauma, 2022."},{"key":"2026070606200703000_11.3.e002186.6","article-title":"The Development of a Trauma Interventional Radiology Alert Protocol Reduces Time to Vessel Puncture in Cases of Active Hemorrhage","volume":"17","author":"Khan","year":"2025","journal-title":"Cureus"},{"key":"2026070606200703000_11.3.e002186.7","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1097\/TA.0000000000001803","article-title":"Effect of door-to-angioembolization time on mortality in pelvic fracture: Every hour of delay counts","volume":"84","author":"Matsushima","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"2026070606200703000_11.3.e002186.8","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.ajem.2025.05.031","article-title":"Balancing the clock: Time thresholds for angioembolization and patient outcomes in pelvic trauma","volume":"95","author":"Huang","year":"2025","journal-title":"Am J Emerg Med"},{"key":"2026070606200703000_11.3.e002186.9","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2020-000663","article-title":"Balloons up: shorter time to angioembolization is associated with reduced mortality in patients with shock and complex pelvic fractures (original study)","volume":"6","author":"O\u2019Connell","year":"2021","journal-title":"Trauma Surg Acute Care Open"},{"key":"2026070606200703000_11.3.e002186.10","doi-asserted-by":"crossref","DOI":"10.1016\/j.injury.2023.111173","article-title":"Does time to angiography affect the survival of trauma patients with embolization to the pelvis? A retrospective study across trauma centers in the United States","volume":"54","author":"Rahal","year":"2023","journal-title":"Injury"},{"key":"2026070606200703000_11.3.e002186.11","doi-asserted-by":"crossref","first-page":"116338","DOI":"10.1016\/j.amjsurg.2025.116338","article-title":"Angioembolization within 60 minutes for exsanguinating trauma patients: A meaningful metric with a definition gap","volume":"244","author":"Gao","year":"2025","journal-title":"Am J Surg"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2025-002186","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:40:01Z","timestamp":1783345201000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2025-002186"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":11,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7,6]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/tsaco-2025-002186"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2025-002186","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}