J. Li1, N. Wang1, J. Friedman1, D. Cron1, O. Juntila1, M. Terjimanian1, E. Chang1, S. C. Wang1 1University Of Michigan,Ann Arbor, MI, USA
Introduction: Motor vehicle crashes (MVCs) are a major cause of traumatic injury in the US, and in-hospital cardiovascular complications are associated with increased morbidity and mortality in this population. The risk of cardiovascular complications is often difficult to predict using only injury severity and vital signs upon presentation to the trauma center. Previous studies have shown analytic morphomics to be a unique domain of perioperative risk assessment and this utility may provide improved clinical insight in the trauma setting. We hypothesized that individualized morphomic factors were associated with in-hospital cardiac complications for patients involved in MVCs.
Methods: Our study included 3,187 MVC adult patients admitted to the University of Michigan Health System who underwent an abdominal CT scan near the time of injury. Exclusion criteria included patients with an Injury Severity Score (ISS) ≤5 or head-and-neck AIS ≥5. Morphomic factors were measured at the L4 vertebral level using established algorithms. We utilized univariate analysis to determine the relationship of patient demographics, comorbidities, morphomics, and vital signs upon hospital admission with the development of cardiovascular complications. Cardiovascular complications were defined as myocardial infarction (MI), cerebrovascular accident (CVA), and other cardiac-arrest events. Injury severity was stratified by mild (5 <ISS <16), moderate (16 <ISS <25), severe (ISS >25) trauma.
Results: Of the 3,187 eligible patients, 3.8% developed cardiovascular complications. CVA and MI history, bone mineral density, and BMI were significant predictors of cardiovascular events (p<0.05) in mild trauma. Decreased average psoas radiodensity and increased age were found to be significant predictors of cardiovascular events (p<0.01) in moderate trauma. Glasgow Coma Scale and increased anterior body depth were the two most significant predictors of cardiovascular events in severe trauma (p<0.05). Table 1 shows the results of the univariate analysis between the complications and non-complications group for all three levels of trauma. Non-significant predictors of cardiovascular complications across all trauma levels include gender (p=0.17, 1.0, 0.11) and history of diabetes (p=0.37, 0.65, 0.19) and hypertension (p=0.50, 0.07, 0.35).
Conclusion: Psoas radiodensity, bone mineral density, and anterior body depth are significant factors associated with cardiovascular complications. Morphomic factors derived from cross-sectional imaging may aid clinical decision making by identifying high risk patients for in-hospital cardiovascular events following MVCs.
