Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients
Kobes, Tim; Sweet, Arthur A R; Klip, IJsbrand T; Houwert, Roderick M; Veldhuis, Wouter B; Leenen, Luke P H; de Jong, Pim A; van Baal, Mark C P M
(2023) European Journal of Trauma and Emergency Surgery, volume 49, issue 3, pp. 1295 - 1302
(Article)
Abstract
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
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between cardiovascular abnormalities visible on routine computed tomography (CT) imaging and outcomes. However, whether this applies to trauma patients is unknown. PURPOSE: 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: 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: 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: 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.
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Keywords: Abdominal aorta calcification, Coronary artery calcification, In-hospital complications, Opportunistic screening, Pulmonary emphysema, Trauma patients, Critical Care and Intensive Care Medicine, Surgery, Emergency Medicine, Orthopedics and Sports Medicine, Journal Article
ISSN: 1863-9933
Publisher: Urban und Vogel
Note: Funding Information: We would like to express our great appreciation to R.H.H. Groenwold, MD, PhD, for his advice on methodology and statistical considerations. Also, our special thanks go out to A. Alnasser, BA, for his help and efforts in improving the language and grammar of this paper. This greatly increased the readability. Publisher Copyright: © 2022, The Author(s).
(Peer reviewed)