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Predictors of Mortality in Blunt Cardiac Injury: A Nationwide Analysis
Khaled El-Qawaqzeh1, Tanya Anand1, Joseph Richards1
1Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
Insights
Blunt cardiac injury (BCI) is rare but deadly after blunt thoracic trauma (BTI). Older age, severe thoracic injuries, and red blood cell transfusions predict BCI, while older age, aortic injury, and heart failure predict mortality.
Area of Science:
- Trauma Surgery
- Cardiology
- Emergency Medicine
Background:
- Blunt thoracic injury (BTI) is a common reason for trauma admissions.
- Blunt cardiac injury (BCI) is an infrequent but serious complication of BTI, associated with significant morbidity and mortality.
- Identifying predictors of BCI and mortality is crucial for improving patient outcomes.
Purpose of the Study:
- To identify independent predictors of concomitant cardiac contusion in patients with BTI.
- To determine predictors of mortality among patients diagnosed with BCI.
- To inform clinical guidelines for timely identification of high-risk BCI patients.
Main Methods:
- Analysis of the American College of Surgeons Trauma Quality Improvement Program (2017).
- Inclusion of adult patients (≥18 years) with BTI, excluding transfers, penetrating injuries, and DOA.
- Primary outcomes: predictors of cardiac contusion in BTI and mortality in BCI patients.
Main Results:
- 125,696 BTI patients identified; 2368 had BCI.
- Predictors of cardiac contusion: age ≥65, high RBC requirements, MVC, and thoracic injuries (hemothorax, flail chest, lung contusion, sternal fracture, diaphragmatic injury, aortic injury).
- Predictors of mortality in BCI: age ≥65, thoracic aortic injury, diaphragmatic injury, hemothorax, and congestive heart failure history.
Conclusions:
- Independent predictors for cardiac contusion and BCI mortality were identified.
- These findings can enhance clinical management by enabling early identification of high-risk individuals.
- Incorporating these predictors into BCI management guidelines is recommended.
Introduction:
Blunt thoracic injury (BTI) is one of the most common causes of trauma admission in the United States and is uncommonly associated with cardiac injuries. Blunt cardiac injury (BCI) after blunt thoracic trauma is infrequent but carries a substantial risk of morbidity and sudden mortality. Our study aims to identify predictors of concomitant cardiac contusion among BTI patients and the predictors of mortality among patients presenting with BCI on a national level.
Materials And Methods:
We performed a 1-y (2017) analysis of the American College of Surgeons Trauma Quality Improvement Program. We included all adults (aged ≥ 18 y) with the diagnosis of BTI. We excluded patients who were transferred, had a penetrating mechanism of injury, and who were dead on arrival. Our primary outcomes were the independent predictors of concomitant cardiac contusions among BTI patients and the predictors of mortality among BCI patients. Our secondary outcome measures were in-hospital complications, differences in injury patterns, and injury severity between the survivors and nonsurvivors of BCI.
Results:
A total of 125,696 patients with BTI were identified, of which 2368 patients had BCI. Mean age was 52 ± 20 y, 67% were male, and median injury severity score was 14 [9-21]. The most common type of cardiac injury was cardiac contusion (43%). Age ≥ 65 y, higher 4-h packed red blood cell requirements, motor vehicle collision mechanism of injury, and concomitant thoracic injuries (hemothorax, flail chest, lung contusion, sternal fracture, diaphragmatic injury, and thoracic aortic injuries) were independently associated with concomitant cardiac contusion among BTI patients (P value < 0.05). Age ≥ 65 y, thoracic aortic injury, diaphragmatic injury, hemothorax, and a history of congestive heart failure were independently associated with mortality in BCI patients (P value < 0.05).
Conclusions:
Predictors of concomitant cardiac contusion among BTI patients and mortality among BCI patients were identified. Guidelines on the management of BCI should incorporate these predictors for timely identification of high-risk patients.
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