Purpose of Review
We provide the readers with a review of cardiac complications in children with multi-system inflammatory syndrome in children (MIS-C) and its short-term outcomes.
Recent Findings
...Recent reports described the acute cardiac manifestations of MIS-C in children and provided a glimpse of the short-term outcomes.
Summary
Children with MIS-C have been reported to acutely have variable degrees of cardiac findings including abnormal cardiac enzymes, abnormal electrocardiographs, decreased systolic function, coronary artery abnormalities from coronary dilation to giant aneurysms, mitral valve regurgitation, tricuspid valve regurgitation, aortic valve insufficiency, pericardial effusion, diastolic dysfunction, abnormal cardiac strain, and abnormal cardiac MRI. The majority of these abnormalities resolved during short-term follow-up. Further studies are needed to assess if transient or persistent cardiac complications are associated with long-term adverse cardiac events in children with MIS-C.
Whole blood (WB) has recently gained increased popularity as an adjunct to the resuscitation of hemorrhaging civilian trauma patients. We aimed to assess the nationwide outcomes of using WB as an ...adjunct to component therapy (CT) versus CT alone in resuscitating geriatric trauma patients.
We performed a 5-y (2017-2021) retrospective analysis of the Trauma Quality Improvement Program. We included geriatric (age, ≥65 y) trauma patients presenting with hemorrhagic shock (shock index >1) and requiring at least 4 units of packed red blood cells in 4 h. Patients with severe head injuries (head Abbreviated Injury Scale ≥3) and transferred patients were excluded. Patients were stratified into WB-CT versus CT only. Primary outcomes were 6-h, 24-h, and in-hospital mortality. Secondary outcomes were major complications. Multivariable regression analysis was performed, adjusting for potential confounding factors.
A total of 1194 patients were identified, of which 141 (12%) received WB. The mean ± standard deviation age was 74 ± 7 y, 67.5% were male, and 83.4% had penetrating injuries. The median interquartile range Injury Severity Score was 19 13-29, with no difference among study groups (P = 0.059). Overall, 6-h, 24-h, and in-hospital mortality were 16%, 23.1%, and 43.6%, respectively. On multivariable regression analysis, WB was independently associated with reduced 24-h (odds ratio, 0.62 0.41-0.94; P = 0.024), and in-hospital mortality (odds ratio, 0.60 0.40-0.90; P = 0.013), but not with major complications (odds ratio, 0.78 0.53-1.15; P = 0.207).
Transfusion of WB as an adjunct to CT is associated with improved early and overall mortality in geriatric trauma patients presenting with severe hemorrhage. The findings from this study are clinically important, as this is an essential first step in prioritizing the selection of WB resuscitation for geriatric trauma patients presenting with hemorrhagic shock.
The aim of this study was to examine the association between the injury mechanism and repair type with outcomes in patients with traumatic inferior vena cava injuries.
This is a retrospective ...analysis of the ACS-TQIP database (2017-2020), including patients with traumatic IVC injuries. Patients were stratified by injury mechanism and type of repair and compared.
Out of 1,334 patients, 5% underwent endovascular repair while 95% had an open procedure. Overall, 74.7% sustained a penetrating injury. On multivariable regression analysis, the type of repair was not associated with mortality and morbidity for patients with penetrating injuries. However, among patients with blunt injuries, endovascular repair was associated with lower odds of in-hospital mortality (aOR:0.35, p=0.020) and non-venous thromboembolism (VTE) morbidity (aOR:0.41, p=0.015), and higher odds of VTE complications (aOR:6.74, p<0.001).
Although the type of repair did not impact morbidity and mortality in patients with penetrating injuries, endovascular repair was identified as the only modifiable predictor of reduced non-VTE morbidity and mortality in patients with blunt injuries.
•Vena Cava Injuries (VCI) result in significant morbidity and mortality regardless of the mechanism of injury.•Type of repair (open vs endovascular) does not impact morbidity and mortality in patients with penetrating VCI.•Among patients with blunt VCI, endovascular repair is associated with reduced mortality and non-venous thromboembolism (VTE) morbidity.•Endovascular repair is associated with higher risk-adjusted odds of VTE complications among blunt VCI.
There is a lack of data on the role of characteristics of injured vessels on the outcomes of patients with blunt cerebrovascular injuries (BCVIs). The aim of this study was to assess the effect of ...the number (single vs multiple) of injured vessels on outcomes.
This is a retrospective study at two American College of Surgeons Level I trauma centers (2017-2021). Adult (>16 years) trauma patients with BCVIs are included. Injuries were graded by the Denver Scale based on the initial computed tomography angiography (CTA). Early repeat CTA was performed 7 to 10 days after diagnosis. Patients were stratified by the number (single vs multiple) of the involved vessels. Outcomes included progression of BCVIs on repeat CTA, stroke, and in-hospital mortality attributable to BCVIs. Multivariable regression analyses were performed to identify the association between the number of injured vessels and outcomes.
A total of 491 patients with 591 injured vessels (285 carotid and 306 vertebral arteries) were identified. Sixty percent were male, the mean age was 44 years, and the median Injury Severity Score was 18 (interquartile range, 11-25). Overall, 18% had multiple-vessel injuries, 16% had bilateral vessel injuries, and 3% had multiple injuries on the same side. The overall rates of progression to higher-grade injuries, stroke, and mortality were 23%, 7.7%, and 8.8%, respectively. On uni- and multivariable analyses, multiple BCVIs were associated with progression to higher-grade injuries on repeat imaging, stroke, and mortality compared with single-vessel injuries.
BCVIs with multiple injured vessels are more likely to progress to higher grades on repeat CTA, with multiple injuries independently associated with worse clinical outcomes, compared with those with single injuries. These findings highlight the importance of incorporating the number of injured vessels in clinical decision-making and in defining protocols for repeat imaging.
We aimed to examine impact of trauma center (TC) surgical stabilization of rib fracture (SSRF) volume on outcomes of patients undergoing SSRF.
Blunt rib fracture patients who underwent SSRF were ...included from ACS-TQIP2017-2021. TCs were stratified according to tertiles of SSRF volume:low (LV), middle, and high (HV). Outcomes were time to SSRF, respiratory complications, prolonged ventilator use, mortality.
16,872 patients were identified (LV:5470,HV:5836). Mean age was 56 years, 74% were male, median thorax-AIS was 3. HV centers had a lower proportion of patients with flail chest (HV41% vs LV50%), pulmonary contusion (HV44% vs LV52%) and had shorter time to SSRF(HV58 vs LV76 h), less respiratory complications (HV3.2% vs LV4.5%), prolonged ventilator use (HV15% vs LV26%), mortality (HV2% vs LV2.6%) (all p < 0.05). On multivariable regression analysis, HV centers were independently associated with reduced time to SSRF(β = −18.77,95%CI = −21.30to-16.25), respiratory complications (OR = 0.67,95%CI = 0.49–0.94), prolonged ventilator use (OR = 0.49,95%CI = 0.41–0.59), but not mortality.
HV SSRF centers have improved outcomes, however, there are variations in threshold for SSRF and indications must be standardized.
Level III.
Therapeutic/Care Management.
•Surgical stabilization of rib fractures (SSRF) at centers with high operative experience in SSRF has improved outcomes.•There are wide variations in the threshold of performing SSRF between high-volume and low-volume centers.•Centers performing 21 annual SSRF cases may be considered as SSRF centers of excellence.
This study aims to evaluate effect of 4-factor PCC on outcomes of severe TBI patients on preinjury anticoagulants undergoing craniotomy/craniectomy.
In this analysis of 2018-2020 ACS-TQIP, patients ...with isolated blunt severe TBI (Head-AIS≥3, nonhead-AIS<2) using preinjury anticoagulants who underwent craniotomy/craniectomy were identified and stratified into PCC and No-PCC groups. Outcomes were time to surgery and mortality. Multivariable binary logistic and linear regression analyses were performed.
1598 patients were identified (PCC-1077 %, No-PCC-149193 %). Mean age was 74(11) years, 65 % were male, median head AIS was 4. Median time to PCC administration was 109 min. On univariable analysis, PCC group had shorter time to surgery (PCC-341, No-PCC-620 min, p = 0.002), but higher mortality (PCC35 %, No-PCC21 %,p = 0.001). On regression analysis, PCC was independently associated with shorter time to surgery (β = -1934,95 %CI = -3339to-26), but not mortality (aOR = 0.70,95 %CI = 0.14-3.62).
PCC may be a safe adjunct for urgent reversal of coagulopathy in TBI patients using preinjury anticoagulants.
This study aims to evaluate the temporal trends of mortality among frail versus non-frail older adult trauma patients during index hospitalization.
We performed a 3-year (2017–2019) analysis of ...ACS-TQIP. We included all older adult (age ≥65 years) trauma patients. Patients were stratified into two groups (Frail vs. Non-Frail). Outcomes were acute (<24 h), early (24–72 h), intermediate (72 hours-1 week), and late (>1 week) mortality.
A total of 1,022,925 older adult trauma patients were identified, of which 19.7 % were frail. The mean(SD) age was 77(8) years and 57.4 % were female. MedianIQR ISS was 94–10 and both groups had comparable injury severity (p = 0.362). On multivariable analysis, frailty was not associated with acute (aOR 1.034; p = 0.518) and early (aOR 1.190; p = 0.392) mortality, while frail patients had independently higher odds of intermediate (aOR 1.269; p = 0.042) and late (aOR 1.835; p < 0.001) mortality. On sub-analysis, our results remained consistent in mild, moderate, and severely injured patients.
Frailty is an independent predictor of mortality in older adult trauma patients who survive the initial 3 days of admission, regardless of injury severity.
•Frailty is known as a predictor of worse clinical outcomes and mortality following injury.•The timing of increased mortality rates in frail patients during hospitalization remains unclear.•Frailty is an independent predictor of mortality in older adult trauma patients who survive the initial 3 days of admission.•Early frailty assessment in identifying high-risk individuals is of paramount importance.
Management of subclavian artery injuries (SAI) and iliac artery injuries (IAI) in adolescent trauma patients poses a considerable challenge due to their complex anatomical locations. The aim of our ...study was to determine the association between the injury mechanism and type of repair with the outcomes of patients with traumatic SAI and IAI.
In this retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database2017-2020, adolescent (<18 y) patients with SAI and IAI undergoing either endovascular or open repair were included. Patients were stratified by mechanism (blunt versus penetrating) and type of repair (endovascular E versus open O) and compared. Outcomes measured were mortality and major complications. Multivariable logistic regression analyses were performed.
Over 4 y, 170 pediatric patients were identified, of which 73 (43%) sustained an SAI and 97 (57%) had IAI. The mean age was 15 and 79% were male. Overall, 39% were managed endovascularly. Both groups had comparable median injury severity score (E: 23 versus O: 25, P = 0.278). For patients with blunt injury (n = 60), the type of repair was neither associated with major complications (E: 39% versus O: 33%, P = 0.694) nor mortality (E: 2.6% versus O: 4.8%, P = 0.651). For patients with penetrating injuries (n = 110), the endovascular repair had significantly lower morbidity (19% versus 41%, P = 0.034) and mortality (3.7% versus 21%, P = 0.041). On multivariable logistic regression, endovascular repair was identified as the only modifiable risk factor associated with reduced mortality (adjusted odds ratio: 0.201, 95% confidence interval 0.14-0.76, P = 0.038).
Difficult-to-access vascular injuries result in significant morbidity and mortality. Endovascular repair was found to be the only modifiable factor associated with decreased mortality of patients with penetrating injury, whereas the type of repair was not associated with mortality in those with blunt injury.
The Synergy Factor: Trauma and Cancer Alexander, Hunter D.; Bhogadi, Sai Krishna; Hejazi, Omar ...
The Journal of surgical research,
October 2024, Letnik:
302
Journal Article
Recenzirano
Trauma and cancer are the leading causes of death in the US. There is a paucity of data describing the impact of cancer on trauma patients. We aimed to determine the influence of cancer on outcomes ...of trauma patients.
In this retrospective analysis of American College of Surgeons-Trauma Quality Improvement Program 2019-2021, we included all adult trauma patients (≥18 y) and excluded patients with severe head injuries and nonmelanomatous skin cancers. Patients were stratified into cancer (C), and no cancer (No-C). Propensity score matching (1:3) was performed. Outcomes were complications and mortality.
A matched cohort of 3236 patients (C, 809; No-C, 2427) was analyzed. The mean age was 70 y, 50.5% were males, and the median injury severity score was 8 (4-10). There were no differences in terms of receiving thromboprophylaxis (C 51%: No-C 50%, P = 0.516). Compared to No-C group, the C group had higher rates of deep vein thrombosis (C 1.1% versus No-C 0.3%, P = 0.004), but there was no difference in terms of overall complications. Patients in the C group had higher mortality (C 7.5% versus No-C 2.7%, P < 0.001).
Trauma patients with cancer have nearly 4 times higher odds of deep vein thrombosis and 3 times higher odds of mortality. Developing pathways specific to cancer patients might be necessary to improve the outcomes of trauma patients with cancer.
There is a lack of data on the outcomes of thoracic damage control surgery (TDCS). This study aimed to describe the characteristics and outcomes of patients undergoing TDCS.
This is a retrospective ...analysis of the American College of Surgeons-Trauma Quality Improvement Program database (2017-2021). All trauma patients who underwent emergency thoracotomy and packing with temporary closure were included. Patients were stratified based on the age groups (pediatric <18 y, adults 18-64 y, and older adults ≥65 y). Our primary outcome measures included 6-h, 24-h, and in-hospital mortality. Secondary outcomes were major complications.
We identified 14,192 thoracotomies, out of which 213 underwent TDCS (pediatric n = 17, adults n = 175, and older adults n = 21). The mean (SD) age was 37 (18), and 86% were male. The mean shock index was 1.1 (0.4) on presentation with a median IQR Glasgow Coma Scale of 4 3-14, and 22.1% had a prehospital cardiac arrest. The study population was profoundly injured with a median injury severity scoreand chest-abbreviated injury scale of 26 17-38 and 4 3-5, respectively, with lung (76.5%) being the most injured intrathoracic organs. Overall, the rates of 6-h, 24-h, and in-hospital mortality were 22.5%, 33%, and 53%, respectively, and 51% developed major complications. There was no significant difference in terms of in-hospital mortality (P = 0.800) and major complications (0.416) among pediatrics, adults, and older adults.
One in three patients undergoing TDCS die within the first 24 h, and more than half of them develop major complications and die in the hospital, with no difference among pediatric, adults, and older adults. Future efforts should be directed to improve the survival of these severely injured, metabolically depleted, challenging patients.
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