1. Association of Early Myocardial Workload and Mortality Following Severe Traumatic Brain Injury.
- Author
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Krishnamoorthy V, Vavilala MS, Chaikittisilpa N, Rivara FP, Temkin NR, Lele AV, Gibbons EF, and Rowhani-Rahbar A
- Subjects
- Abbreviated Injury Scale, Adolescent, Adult, Age Factors, Aged, Blood Pressure physiology, Brain Injuries, Traumatic physiopathology, Databases as Topic, Female, Glasgow Coma Scale, Heart Rate physiology, Hospital Mortality, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, United States epidemiology, Young Adult, Brain Injuries, Traumatic mortality, Heart physiopathology
- Abstract
Objectives: To examine the impact of early myocardial workload on in-hospital mortality following isolated severe traumatic brain injury., Design: Retrospective cohort study., Setting: Data from the National Trauma Databank, a multicenter trauma registry operated by the American College of Surgeons, from 2007 to 2014., Patients: Adult patients with isolated severe traumatic brain injury (defined as admission Glasgow Coma Scale < 8 and head Abbreviated Injury Score ≥ 4)., Interventions: Admission rate-pressure product, categorized into five levels based on published low, normal, and submaximal human thresholds: less than 5,000; 5,000-9,999; 10,000-14,999; 15,000-19,999; and greater than 20,000., Measurements and Main Results: Data from 26,412 patients were analyzed. Most patients had a normal rate-pressure product (43%), 35% had elevated rate-pressure product, and 22% had depressed rate-pressure product at hospital admission. Compared with the normal rate-pressure product group, in-hospital mortality was 22 percentage points higher in the lowest rate-pressure product group (cumulative mortality, 50.2%; 95% CI, 43.6-56.9%) and 11 percentage points higher in the highest rate-pressure product group (cumulative mortality, 39.2%; 95% CI, 37.4-40.9%). The lowest rate-pressure product group was associated with a 50% increased risk of mortality, compared with the normal rate-pressure product group (adjusted relative risk, 1.50; 95% CI, 1.31-1.76%; p < 0.0001), and the highest rate-pressure product group was associated with a 25% increased risk of mortality, compared with the normal rate-pressure product group (adjusted relative risk, 1.25; 95% CI, 1.18-1.92%; p < 0.0001). This relationship was blunted with increasing age. Among patients with normotension, those with depressed and elevated rate-pressure products experienced increased mortality., Conclusions: Adults with severe traumatic brain injury experience heterogeneous myocardial workload profiles that have a "U-shaped" relationship with mortality, even in the presence of a normal blood pressure. Our findings are novel and suggest that cardiac performance is important following severe traumatic brain injury.
- Published
- 2018
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