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European Journal of Trauma and Emergency Surgery

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Open Access 27-11-2022 | Computed Tomography | Original Article

Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients

Authors: Tim Kobes, M.D., Arthur A. R. Sweet, M.D., IJsbrand T. Klip, M.D., Ph.D., Roderick M. Houwert, M.D., Ph.D., Wouter B. Veldhuis, M.D., Ph.D., Luke P. H. Leenen, M.D., Ph.D., Pim A. de Jong, M.D., Ph.D., Mark C. P. M. van Baal, M.D., Ph.D.

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2023

Abstract

Background

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.

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Title: Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients
Authors: Tim Kobes, M.D.
Arthur A. R. Sweet, M.D.
IJsbrand T. Klip, M.D., Ph.D.
Roderick M. Houwert, M.D., Ph.D.
Wouter B. Veldhuis, M.D., Ph.D.
Luke P. H. Leenen, M.D., Ph.D.
Pim A. de Jong, M.D., Ph.D.
Mark C. P. M. van Baal, M.D., Ph.D.
Publication date: 27-11-2022
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Pulmonary Emphysema
Published in: European Journal of Trauma and Emergency Surgery / Issue 3/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-02168-7

At a glance: The STEP trials

Springer Medicine

Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients

Abstract

Background

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Purpose

Methods

Results

Conclusion

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