The Journal of surgical research · 2025
Trauma Outcomes in Patients With a History of Cerebrovascular Accident.
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Ekelmans Adrianus, Rafieezadeh Aryan, Prabhakaran Kartik, Jose Anna, Kirsch Jordan, Shnaydman Ilya, Klein Joshua, Froula Gabriel, Zangbar Bardiya
Аннотация
INTRODUCTION: Outcomes of traumatic brain injury (TBI) have been studied extensively; however, outcomes in TBI patients with a history of cerebrovascular accident (HxCVA) are not well defined. Here, we aimed to compare outcomes in TBI patients with and without a history of CVA (HwoCVA).
METHODS: Using Trauma Quality Improvement Database, adult patients (age ≥18) with isolated blunt TBI from 2017 to 2019 were selected. Transferred patients and those who were dead on arrival were excluded. Patients were then grouped based on CVA history. Morality, hospital disposition, hospital and intensive care unit (ICU) length of stay were compared.
RESULTS: A total of 655,686 patients were identified. The HxCVA group (n = 23,482) were older (72.18 ± 12.1 y versus 54.10 ± 21.28 y, P < 0.001) and had a lower injury severity score (13.60 ± 8.4 versus 14.33 ± 10.4, P < 0.001) than HwoCVA. Total Glasgow Coma Score was higher in HxCVA patients (13.58 ± 3.9 versus 12.99 ± 3.0, P < 0.001). Mortality rates were higher in HxCVA (8.39% versus 7.94%, P < 0.001). Hospital disposition was significantly different between groups (P < 0.001) with HxCVA more likely to be discharged to a nursing facility (22.88% versus 9.11%). The mean hospital length of stay was significantly higher in the HxCVA (7.10 ± 13.35 d versus and 6.68 ± 10.30 d, P < 0.001), in comparison to HwoCVA. However, ICU length of stay was significantly lower in HxCVA (4.46 ± 5.22 d versus 5.44 ± 6.98 d, P < 0.001). HxCVA significantly increased odds of mortality (odds ratio: 1.283, 95% confidence interval: 1.208-1.363, P < 0.001).
CONCLUSIONS: TBI patients with an HxCVA were associated with increased odds of mortality, spent more days in the hospital, and less days in the ICU in comparison to TBI patients HwoCVA.
METHODS: Using Trauma Quality Improvement Database, adult patients (age ≥18) with isolated blunt TBI from 2017 to 2019 were selected. Transferred patients and those who were dead on arrival were excluded. Patients were then grouped based on CVA history. Morality, hospital disposition, hospital and intensive care unit (ICU) length of stay were compared.
RESULTS: A total of 655,686 patients were identified. The HxCVA group (n = 23,482) were older (72.18 ± 12.1 y versus 54.10 ± 21.28 y, P < 0.001) and had a lower injury severity score (13.60 ± 8.4 versus 14.33 ± 10.4, P < 0.001) than HwoCVA. Total Glasgow Coma Score was higher in HxCVA patients (13.58 ± 3.9 versus 12.99 ± 3.0, P < 0.001). Mortality rates were higher in HxCVA (8.39% versus 7.94%, P < 0.001). Hospital disposition was significantly different between groups (P < 0.001) with HxCVA more likely to be discharged to a nursing facility (22.88% versus 9.11%). The mean hospital length of stay was significantly higher in the HxCVA (7.10 ± 13.35 d versus and 6.68 ± 10.30 d, P < 0.001), in comparison to HwoCVA. However, ICU length of stay was significantly lower in HxCVA (4.46 ± 5.22 d versus 5.44 ± 6.98 d, P < 0.001). HxCVA significantly increased odds of mortality (odds ratio: 1.283, 95% confidence interval: 1.208-1.363, P < 0.001).
CONCLUSIONS: TBI patients with an HxCVA were associated with increased odds of mortality, spent more days in the hospital, and less days in the ICU in comparison to TBI patients HwoCVA.