Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients

Abstract text (incl. references and figure legends)

Introduction: In-hospital complications after trauma may result in prolonged stays, higher costs, and adverse functional outcomes. Among reported risk factors for complications are pre-existing cardiopulmonary comorbidities. Objective and quick evaluation of cardiovascular risk would be beneficial for risk assessment. We aimed to assess the association between cardiopulmonary abnormalities visible on routine CT images and the development of in-hospital complications in level-1 trauma patients.

Material & Methods: All admitted trauma patients (≥16y) with CT imaging of the abdomen, thorax, or spine and in 2017 were included. Patients with active infection upon admission or severe neurological trauma were excluded. Routine trauma CT images were analyzed for visible abnormalities: pulmonary emphysema, coronary artery calcifications, and abdominal aorta calcification. Drug-treated complications were scored. Discharge condition was scored on the Glasgow Outcome Scale.

Results: 433 patients (median age 50y, 67% male, 89% ASA 1-2) were analyzed. Median ISS and GCS score were 9 and 15, respectively. 76 patients suffered from at least one complication, mostly pneumonia (n=39, 9%) or delirium (n=19, 4%). Left main coronary artery calcification was independently associated with complications (OR 3.9, 95%CI 1.7–8.9). An increasing number of calcified coronary arteries showed a trend towards an association with complications (p=0.07) and was significantly associated with an adverse discharge condition (p=0.02). Pulmonary emphysema and aortic calcifications were not associated with complications.

Conclusions: Coronary artery calcification, visible on routine CT imaging, is independently associated with in-hospital complications and an adverse discharge condition in level-1 trauma patients. The findings of this study may help to identify trauma patients quickly and objectively at risk for complications in an early stage without performing additional diagnostics or interventions.

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