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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 6/2022

Open Access 27-11-2021 | Central Nervous System Trauma | Original Article

Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index

Authors: Maximilian Peter Forssten, Gary Alan Bass, Kai-Michael Scheufler, Ahmad Mohammad Ismail, Yang Cao, Niels Douglas Martin, Babak Sarani, Shahin Mohseni

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2022

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Abstract

Purpose

Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients.

Methods

All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference.

Results

259,399 patients met the study’s inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01–1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05–1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11–1.90), p = 0.006], compared to RCRI 0.

Conclusion

An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population.
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Metadata
Title
Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index
Authors
Maximilian Peter Forssten
Gary Alan Bass
Kai-Michael Scheufler
Ahmad Mohammad Ismail
Yang Cao
Niels Douglas Martin
Babak Sarani
Shahin Mohseni
Publication date
27-11-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 6/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-021-01841-7

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