Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Eur J Trauma Emerg Surg. 2023 Jun;49(3):1295-1302. doi: 10.1007/s00068-022-02168-7. Epub 2022 Nov 27.
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.
创伤后的院内并发症可能导致住院时间延长、费用增加和功能预后不良。报告的并发症风险因素包括预先存在的心肺合并症。对心血管风险进行客观、快速的评估将有助于对创伤患者进行风险评估。非创伤患者的研究表明，常规计算机断层扫描（CT）成像上可见的心血管异常与结局之间存在独立关联。然而，这是否适用于创伤患者尚不清楚。
评估在 1 级创伤中心的患者中，常规 CT 图像上可见的心肺异常与院内并发症发展之间的关系。
纳入 2017 年在乌得勒支大学医学中心接受腹部、胸部或脊柱 CT 成像且年龄在 16 岁及以上的所有创伤患者。入院时患有活动性感染或严重神经创伤的患者被排除在外。对常规创伤 CT 图像进行分析，以确定是否存在可见异常：肺气肿、冠状动脉钙化和腹主动脉钙化严重程度。药物治疗并发症进行评分。格拉斯哥结局量表（Glasgow Outcome Scale）用于测量出院情况。
共分析了 433 名患者（中位年龄 50 岁，67%为男性，89%为 ASA 1-2 级）。损伤严重程度评分和格拉斯哥昏迷评分中位数分别为 9 分和 15 分。76 名患者至少患有一种并发症，主要为肺炎（n=39，9%）或谵妄（n=19，4%）。左主干冠状动脉钙化与任何并发症的发生独立相关（OR 3.9，95%CI 1.7-8.9）。冠状动脉钙化数量的增加与并发症呈趋势相关（p=0.07），与不良出院情况显著相关（p=0.02）。肺气肿和主动脉钙化与并发症无关。
常规 CT 成像上可见的冠状动脉钙化与 1 级创伤患者的院内并发症和不良出院情况独立相关。本研究结果可能有助于在无需进行额外诊断或干预的情况下，快速、客观地识别出早期处于并发症风险中的创伤患者。
