The revised cardiac risk index is associated with morbidity and mortality independent of injury severity in elderly patients with rib fractures

Authors

Gary Alan Bass, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; School of Medical Sciences, Orebro University, Orebro, Sweden; Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, USA; Center for Peri-Operative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, USA.
Caoimhe C. Duffy, Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, USA; Center for Peri-Operative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, USA.
Lewis J. Kaplan, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Anesthesia and Critical Care, University of Pennsylvania, Philadelphia, USA; Corporal Michael Cresenscz Veterans Affairs Medical Center (CMCVAMC), Philadelphia, USA.
Babak Sarani, Center for Trauma and Critical Care, George Washington University School of Medicine & Health Sciences, Washington D.C., USA.
Niels D. Martin, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
Ahmad Mohammad Ismail, School of Medical Sciences, Orebro University, Orebro, Sweden.
Yang Cao, Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden.
Maximilian Peter Forssten, School of Medical Sciences, Orebro University, Orebro, Sweden.
Shahin Mohseni, School of Medical Sciences, Orebro University, Orebro, Sweden; Division of Trauma & Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden. Electronic address: shahin.mohseni@oru.se.

Document Type

Journal Article

Publication Date

11-13-2022

Journal

Injury

DOI

10.1016/j.injury.2022.11.039

Keywords

Geriatric; Revised cardiac risk index; Rib fracture; Risk stratification; Thoracic trauma

Abstract

BACKGROUND: Risk factors for mortality and in-hospital morbidity among geriatric patients with traumatic rib fractures remain unclear. Such patients are often frail and demonstrate a high comorbidity burden. Moreover, outcomes anticipated by current rubrics may reflect the influence of multisystem injury or surgery, and thus not apply to isolated injuries in geriatric patients. We hypothesized that the Revised Cardiac Risk Index (RCRI) may assist in risk-stratifying geriatric patients following rib fracture. METHODS: All geriatric patients (age ≥65 years) with a conservatively managed rib fracture owing to an isolated thoracic injury (thorax AIS ≥1), in the 2013-2019 TQIP database were assessed including demographics and outcomes. The association between the RCRI and in-hospital morbidity as well as mortality was analyzed using Poisson regression models while adjusting for potential confounders. RESULTS: 96,750 geriatric patients sustained rib fractures. Compared to those with RCRI 0, patients with an RCRI score of 1 had a 16% increased risk of in-hospital mortality [adjusted incidence rate ratio (adj-IRR), 95% confidence interval (CI): 1.16 (1.02-1.32), p=0.020]. An RCRI score of 2 [adj-IRR (95% CI): 1.72 (1.44-2.06), p<0.001] or ≥3 [adj-IRR (95% CI): 3.07 (2.31-4.09), p<0.001] was associated with an even greater mortality risk. Those with an increased RCRI also exhibited a higher incidence of myocardial infarction, cardiac arrest, stroke, and acute respiratory distress syndrome. CONCLUSIONS: Geriatric patients with rib fractures and an RCRI ≥1 represent a vulnerable and high-risk group. This index may inform the decision to admit for inpatient care and can also guide patient and family counseling as well as computer-based decision-support.

APA Citation

Bass, Gary Alan; Duffy, Caoimhe C.; Kaplan, Lewis J.; Sarani, Babak; Martin, Niels D.; Ismail, Ahmad Mohammad; Cao, Yang; Forssten, Maximilian Peter; and Mohseni, Shahin, "The revised cardiac risk index is associated with morbidity and mortality independent of injury severity in elderly patients with rib fractures" (2022). GW Authored Works. Paper 1941.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1941

Department

Surgery