The revised cardiac risk index is associated with morbidity and mortality independent of injury severity in elderly patients with rib fractures.

Humans Aged Rib Fractures / complications Morbidity Thoracic Injuries / complications Myocardial Infarction / epidemiology Risk Factors Retrospective Studies Injury Severity Score
Geriatric Revised cardiac risk index Rib fracture Risk stratification Thoracic trauma

Journal

Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040

Informations de publication

Date de publication:
Jan 2023
Historique:
received: 22 09 2022
revised: 23 10 2022
accepted: 10 11 2022
pubmed: 20 11 2022
medline: 4 1 2023
entrez: 19 11 2022
Statut: ppublish

Résumé

Risk factors for mortality and in-hospital morbidity among geriatric patients with traumatic rib fractures remain unclear. Such patients are often frail and demonstrate a high comorbidity burden. Moreover, outcomes anticipated by current rubrics may reflect the influence of multisystem injury or surgery, and thus not apply to isolated injuries in geriatric patients. We hypothesized that the Revised Cardiac Risk Index (RCRI) may assist in risk-stratifying geriatric patients following rib fracture. All geriatric patients (age ≥65 years) with a conservatively managed rib fracture owing to an isolated thoracic injury (thorax AIS ≥1), in the 2013-2019 TQIP database were assessed including demographics and outcomes. The association between the RCRI and in-hospital morbidity as well as mortality was analyzed using Poisson regression models while adjusting for potential confounders. 96,750 geriatric patients sustained rib fractures. Compared to those with RCRI 0, patients with an RCRI score of 1 had a 16% increased risk of in-hospital mortality [adjusted incidence rate ratio (adj-IRR), 95% confidence interval (CI): 1.16 (1.02-1.32), p=0.020]. An RCRI score of 2 [adj-IRR (95% CI): 1.72 (1.44-2.06), p<0.001] or ≥3 [adj-IRR (95% CI): 3.07 (2.31-4.09), p<0.001] was associated with an even greater mortality risk. Those with an increased RCRI also exhibited a higher incidence of myocardial infarction, cardiac arrest, stroke, and acute respiratory distress syndrome. Geriatric patients with rib fractures and an RCRI ≥1 represent a vulnerable and high-risk group. This index may inform the decision to admit for inpatient care and can also guide patient and family counseling as well as computer-based decision-support.

Sections du résumé

BACKGROUND BACKGROUND
Risk factors for mortality and in-hospital morbidity among geriatric patients with traumatic rib fractures remain unclear. Such patients are often frail and demonstrate a high comorbidity burden. Moreover, outcomes anticipated by current rubrics may reflect the influence of multisystem injury or surgery, and thus not apply to isolated injuries in geriatric patients. We hypothesized that the Revised Cardiac Risk Index (RCRI) may assist in risk-stratifying geriatric patients following rib fracture.
METHODS METHODS
All geriatric patients (age ≥65 years) with a conservatively managed rib fracture owing to an isolated thoracic injury (thorax AIS ≥1), in the 2013-2019 TQIP database were assessed including demographics and outcomes. The association between the RCRI and in-hospital morbidity as well as mortality was analyzed using Poisson regression models while adjusting for potential confounders.
RESULTS RESULTS
96,750 geriatric patients sustained rib fractures. Compared to those with RCRI 0, patients with an RCRI score of 1 had a 16% increased risk of in-hospital mortality [adjusted incidence rate ratio (adj-IRR), 95% confidence interval (CI): 1.16 (1.02-1.32), p=0.020]. An RCRI score of 2 [adj-IRR (95% CI): 1.72 (1.44-2.06), p<0.001] or ≥3 [adj-IRR (95% CI): 3.07 (2.31-4.09), p<0.001] was associated with an even greater mortality risk. Those with an increased RCRI also exhibited a higher incidence of myocardial infarction, cardiac arrest, stroke, and acute respiratory distress syndrome.
CONCLUSIONS CONCLUSIONS
Geriatric patients with rib fractures and an RCRI ≥1 represent a vulnerable and high-risk group. This index may inform the decision to admit for inpatient care and can also guide patient and family counseling as well as computer-based decision-support.

Identifiants

DOI: 10.1016/j.injury.2022.11.039 PMID: 36402584
pubmed: 36402584
pii: S0020-1383(22)00868-3
doi: 10.1016/j.injury.2022.11.039
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

56-62

Informations de copyright

Copyright © 2022. Published by Elsevier Ltd.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors have no conflicts of interest to declare and have received no financial benefit in the execution of this study.

Auteurs

Gary Alan Bass (GA)

Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; School of Medical Sciences, Orebro University, Orebro, Sweden; Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, USA; Center for Peri-Operative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, USA.

Caoimhe C Duffy (CC)

Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, USA; Center for Peri-Operative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, USA.

Lewis J Kaplan (LJ)

Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Anesthesia and Critical Care, University of Pennsylvania, Philadelphia, USA; Corporal Michael Cresenscz Veterans Affairs Medical Center (CMCVAMC), Philadelphia, USA.

Babak Sarani (B)

Center for Trauma and Critical Care, George Washington University School of Medicine & Health Sciences, Washington D.C., USA.

Niels D Martin (ND)

Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.

Ahmad Mohammad Ismail (AM)

School of Medical Sciences, Orebro University, Orebro, Sweden.

Yang Cao (Y)

Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden.

Maximilian Peter Forssten (MP)

School of Medical Sciences, Orebro University, Orebro, Sweden.

Shahin Mohseni (S)

School of Medical Sciences, Orebro University, Orebro, Sweden; Division of Trauma & Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden. Electronic address: shahin.mohseni@oru.se.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The revised cardiac risk index is associated...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › The revised cardiac risk index is associated...
questionsmedicales.fr › Plaies et blessures › Blessures du thorax › Fractures de côte › The revised cardiac risk index is associated...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › The revised cardiac risk index is associated...
questionsmedicales.fr › Plaies et blessures › Blessures du thorax › The revised cardiac risk index is associated...
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questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › The revised cardiac risk index is associated...
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