Abstract P60: Mortality from Severe Trauma in Patients with Pre-existing Cardiac Disease

Abstract

BACKGROUND: We observed significant morbidity and mortality in patients who suffer severe traumatic injuries with pre-existing cardiac disease. We wondered about the cardiac risks factors that predispose to worse outcomes in these patients. METHODS: We reviewed 10,144 trauma admissions to the University of Kentucky over a 5 year period (2002 to 2007) in patients 21 years or older. The types and extent of injuries were characterized and risk factors for poor outcome were assessed. RESULTS: Of the 10,144 trauma patients, adequate cardiovascular history was obtained before emergency treatment in 5971 patients (58.9%). Of the 700 trauma deaths, 236 (33.7%) had adequate medical history to allow accurate assessment of cardiovascular risk. Severe head & chest injuries caused death in most patients (79.2%). Significant multivariate predictors of trauma-related death in this cohort included Glascow coma score (O.R. = 1.266/score unit), older age (O.R. = 0.931/year), injury severity score (O.R. = 1.096/unit score), major burn (O.R. = 7.36), assault with a weapon (O.R. = 3.236), and female gender (O.R. = 1.561). Importantly, after propensity adjustment, significant cardiovascular mortality risks included pre-injury warfarin therapy, congestive heart failure (CHF), & beta-blocker use. The highest mortality rates occurred in patients with combinations of these cardiovascular risk factors (see table ). CONCLUSIONS: Pre-injury cardiac risk factors, especially pre-injury warfarin, beta-blocker use and CHF, are independent multivariate predictors of mortality in patients suffering significant trauma. Patients with more than one pre-injury cardiac risk factor have 2 to 4 times the mortality risk compared to those without cardiac risks. : Category (Complete) : Miscellaneous Keyword (Complete) : Trauma ; Cardiac risks ; warfarin Samson Resident Award (Complete): *Paul C. Samson Award (Required) : No Status: Complete Propensity Adjusted Cardiovascular Risk Factors for Trauma Mortality (C-statistic = 0.940)