Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients.
Abdominal aorta calcification
Coronary artery calcification
In-hospital complications
Opportunistic screening
Pulmonary emphysema
Trauma patients
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
20
07
2022
accepted:
04
11
2022
medline:
1
6
2023
pubmed:
28
11
2022
entrez:
27
11
2022
Statut:
ppublish
Résumé
In-hospital complications after trauma may result in prolonged stays, higher costs, and adverse functional outcomes. Among reported risk factors for complications are pre-existing cardiopulmonary comorbidities. Objective and quick evaluation of cardiovascular risk would be beneficial for risk assessment in trauma patients. Studies in non-trauma patients suggested an independent association between cardiovascular abnormalities visible on routine computed tomography (CT) imaging and outcomes. However, whether this applies to trauma patients is unknown. To assess the association between cardiopulmonary abnormalities visible on routine CT images and the development of in-hospital complications in patients in a level-1 trauma center. All trauma patients aged 16 years or older with CT imaging of the abdomen, thorax, or spine and admitted to the UMC Utrecht in 2017 were included. Patients with an active infection upon admission or severe neurological trauma were excluded. Routine trauma CT images were analyzed for visible abnormalities: pulmonary emphysema, coronary artery calcifications, and abdominal aorta calcification severity. Drug-treated complications were scored. The discharge condition was measured on the Glasgow Outcome Scale. In total, 433 patients (median age 50 years, 67% male, 89% ASA 1-2) were analyzed. Median Injury Severity Score and Glasgow Coma Scale score were 9 and 15, respectively. Seventy-six patients suffered from at least one complication, mostly pneumonia (n = 39, 9%) or delirium (n = 19, 4%). Left main coronary artery calcification was independently associated with the development of any complication (OR 3.9, 95% CI 1.7-8.9). An increasing number of calcified coronary arteries showed a trend toward an association with complications (p = 0.07) and was significantly associated with an adverse discharge condition (p = 0.02). Pulmonary emphysema and aortic calcifications were not associated with complications. Coronary artery calcification, visible on routine CT imaging, is independently associated with in-hospital complications and an adverse discharge condition in level-1 trauma patients. The findings of this study may help to identify trauma patients quickly and objectively at risk for complications in an early stage without performing additional diagnostics or interventions.
Sections du résumé
BACKGROUND
BACKGROUND
In-hospital complications after trauma may result in prolonged stays, higher costs, and adverse functional outcomes. Among reported risk factors for complications are pre-existing cardiopulmonary comorbidities. Objective and quick evaluation of cardiovascular risk would be beneficial for risk assessment in trauma patients. Studies in non-trauma patients suggested an independent association between cardiovascular abnormalities visible on routine computed tomography (CT) imaging and outcomes. However, whether this applies to trauma patients is unknown.
PURPOSE
OBJECTIVE
To assess the association between cardiopulmonary abnormalities visible on routine CT images and the development of in-hospital complications in patients in a level-1 trauma center.
METHODS
METHODS
All trauma patients aged 16 years or older with CT imaging of the abdomen, thorax, or spine and admitted to the UMC Utrecht in 2017 were included. Patients with an active infection upon admission or severe neurological trauma were excluded. Routine trauma CT images were analyzed for visible abnormalities: pulmonary emphysema, coronary artery calcifications, and abdominal aorta calcification severity. Drug-treated complications were scored. The discharge condition was measured on the Glasgow Outcome Scale.
RESULTS
RESULTS
In total, 433 patients (median age 50 years, 67% male, 89% ASA 1-2) were analyzed. Median Injury Severity Score and Glasgow Coma Scale score were 9 and 15, respectively. Seventy-six patients suffered from at least one complication, mostly pneumonia (n = 39, 9%) or delirium (n = 19, 4%). Left main coronary artery calcification was independently associated with the development of any complication (OR 3.9, 95% CI 1.7-8.9). An increasing number of calcified coronary arteries showed a trend toward an association with complications (p = 0.07) and was significantly associated with an adverse discharge condition (p = 0.02). Pulmonary emphysema and aortic calcifications were not associated with complications.
CONCLUSION
CONCLUSIONS
Coronary artery calcification, visible on routine CT imaging, is independently associated with in-hospital complications and an adverse discharge condition in level-1 trauma patients. The findings of this study may help to identify trauma patients quickly and objectively at risk for complications in an early stage without performing additional diagnostics or interventions.
Identifiants
pubmed: 36436070
doi: 10.1007/s00068-022-02168-7
pii: 10.1007/s00068-022-02168-7
pmc: PMC10229702
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1295-1302Informations de copyright
© 2022. The Author(s).
Références
J Orthop Traumatol. 2017 Jun;18(2):151-158
pubmed: 27848054
Eur J Surg Oncol. 2018 May;44(5):587-593
pubmed: 29452856
Crit Care. 2020 May 15;24(1):223
pubmed: 32414401
Inflamm Res. 2002 May;51(5):265-72
pubmed: 12056515
PLoS One. 2011;6(10):e26036
pubmed: 22022499
Rev Esc Enferm USP. 2021 Aug 20;55:e20200467
pubmed: 34423803
JACC Cardiovasc Imaging. 2018 Nov;11(11):1718-1719
pubmed: 29680342
Arch Orthop Trauma Surg. 2017 Apr;137(4):507-515
pubmed: 28233062
Eur Radiol. 2015 Jan;25(1):65-71
pubmed: 25182625
PLoS One. 2020 Jan 24;15(1):e0228082
pubmed: 31978109
South Med J. 2012 Jun;105(6):306-10
pubmed: 22665153
JMIR Hum Factors. 2019 Sep 26;6(3):e14819
pubmed: 31573897
J Atheroscler Thromb. 2019 May 1;26(5):452-464
pubmed: 30381612
Expert Rev Respir Med. 2019 Apr;13(4):381-397
pubmed: 30761929
Sci Rep. 2021 Jul 5;11(1):13803
pubmed: 34226621
J Trauma. 2001 Jan;50(1):91-5
pubmed: 11231676
Clin Geriatr Med. 2009 Nov;25(4):563-77, vii
pubmed: 19944261
Trauma Surg Acute Care Open. 2021 Mar 26;6(1):e000667
pubmed: 33869787
J Neurotrauma. 2020 Apr 1;37(7):1002-1010
pubmed: 31672086
Arch Surg. 2012 Feb;147(2):152-8
pubmed: 22351910
J Am Coll Cardiol. 2008 Mar 4;51(9):885-92
pubmed: 18308155
J Am Coll Cardiol. 2016 Sep 13;68(11):1233-1246
pubmed: 27609687
JAMA Surg. 2016 Jul 1;151(7):622-30
pubmed: 26842660
N Engl J Med. 2009 Mar 5;360(10):961-72
pubmed: 19228612
Circulation. 2019 Sep 10;140(11):e596-e646
pubmed: 30879355
Int J Surg. 2020 Oct;82:116-120
pubmed: 32853781
Arch Surg. 2011 Jul;146(7):794-801
pubmed: 21422331
Eur J Trauma Emerg Surg. 2013 Aug;39(4):375-83
pubmed: 26815398