Have echocardiograms affected recommended therapy in geriatric trauma patients?

Geriatric trauma patients tend to have worse outcomes than their younger counterparts. The American Heart Association (AHA) recommends preoperative cardiac clearance to stratify patients according to perioperative cardiac risk. The utility of this in the trauma setting remains unclear. We sought to identify the role of preoperative echocardiograms (echo) in geriatric trauma patients.

We performed a retrospective review of geriatric trauma patients who required operative intervention over a 1-year period. Patients with echocardiograms performed were compared with those who did not.

Three-hundred thirty geriatric trauma patients required an operation. A preoperative echo was performed in 25% (82/330). Abnormalities on echocardiogram were identified in 13% (11/82) of patients. One patient had a change in management based on the echo. None of the patients who died in the perioperative period had a management alteration as a result of the echo. Echo patients had a longer LOS and to operative intervention (P<.006).

Echocardiograms had an exceeding low rate of management change in the acutely injured geriatric trauma patient. Further studies to evaluate the need for echocardiogram in this population are warranted.