1 / 23

Mortality From Severe Trauma in Patients With Pre-existing Cardiac Disease

Mortality From Severe Trauma in Patients With Pre-existing Cardiac Disease. V. A. Ferraris , S. P. Ferraris, S. P. Saha, Cardiothoracic Surgery, University of Kentucky, Lexington, KY, . Trauma mortality often depends on co-morbidities.

dustin
Download Presentation

Mortality From Severe Trauma in Patients With Pre-existing Cardiac Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Mortality From Severe Trauma in Patients With Pre-existing Cardiac Disease V. A. Ferraris, S. P. Ferraris, S. P. Saha, Cardiothoracic Surgery, University of Kentucky, Lexington, KY,

  2. Trauma mortality often depends on co-morbidities. Cardiovascular co-morbidity seemed like a major risk factor in patients who suffer severe trauma. Large database available at a busy trauma center. Background

  3. Background – The Real Reason • 5 years of M&M conference

  4. Methods • All trauma patients at a major trauma center added to a concurrent database. • Exclusions from study group • Age ≤ 20 years. • Patients unable to have adequate cardiac history. • Types & extent of injuries characterized. • Multivariate analysis w/ propensity adjustment used to identify independent risks for mortality.

  5. Trauma Patient Population

  6. Trauma Mortality

  7. Causes of Death Based on Most Severe Injury

  8. Age & Trauma Mortality

  9. Risk Factors & Trauma Mortality

  10. Drug History & Trauma Mortality

  11. Clopidogrel & Trauma Mortality

  12. Does Coronary Revascularization Protect Trauma Patients?

  13. Cardiovascular Risk Factors For Trauma Mortality 5971 adult trauma patients

  14. Continuous Variables & Trauma Mortality 5971 Trauma Patients

  15. Multivariate Predictors of Trauma Mortality (Propensity Adjusted)

  16. Multivariate Cardiac Risks For Trauma Mortality

  17. Shortcomings • Multiple patients without adequate cardiac history. • Likely underestimate of mortality risk associated with cardiac disease. • Observational study not able to prove cause & effect. • Conclusions may not be applicable to all trauma patients.

  18. Conclusions • Severe trauma in patients with cardiac disease is associated with increased mortality. • Multiple cardiovascular risks are associated with mortalities 4 to 5 times normal. • Head trauma remains a major cause of trauma death. • Beta-blocker use, pre-injury warfarin, & CHF are major cardiovascular risks for mortality in trauma.

  19. Conclusions (Continued) • Don’t fall asleep during M&M! • Take an idea and run with it!

  20. Conclusions (Continued) • Help is Available! • Dan Davenport • Linda Combs • Faculty

  21. Important Things to Remember • Retrospective reviews are ‘hypothesis generating’. • Only looked at about ½ of the database • Probably underestimate of mortality risks.

  22. Where Do We Go From Here? Hypotheses to be tested! • Take careful drug history in trauma patients • Test for anti-coagulation, especially in in older patients – clopidogrel may be emerging risk. • Rapid reversal of anti-coagulation may save lives (Factor VII, Beriplex, etc.) • Pre-injury beta-blocker is bad but post-injury may be ok. • Optimize cardiac function • Cardiotonic drugs, IABP, etc.

  23. Questions or Comments

More Related