M. Altieri1, I. Almasry2, M. J. Shapiro1, J. A. Vosswinkel1, J. E. McCormack1, E. C. Huang1, P. Eckardt3, R. S. Jawa1 1Stony Brook University Medical Center,Trauma,Stony Brook, NY, USA 2Stony Brook University Medical Center,Cardiology,Stony Brook, NY, USA 3Stony Brook University Medical Center,Nursing,Stony Brook, NY, USA
Introduction: The prevalence of Implanted cardioverter defibrillators (ICDs) and pacemakers (PMs) in the US population is increasing. However, the prevalence and outcomes of patients with these devices after trauma is unknown.
Methods: The trauma registry at a regional trauma center was retrospectively reviewed for adult blunt trauma patients with age≥ 60 years admittd between January 2007 and June 2014. Deaths in the emergency department were excluded.
Results: 145 patients were admitted with ICDs, 234 patients with PMs, and 3,814 patients with no device (ND). ICD patients had ≥ 2 National Trauma Data Standard (NTDS) comorbidities more often than the other groups (93.1%# vs 78.6%PM vs 58.3%ND*,^). The most frequent major injury (AIS≥3) location was head/neck (43.4% ICD vs 35.0% PM vs 31.9%^ND) followed by extremities (24.1% ICD vs 32.5% PM vs 30.7% ND) in all groups. ICD patients had significantly longer hospital (8 vs 7 days) and ICU LOS (6 vs 4 days) than PM patients. Major surgery was required in similar frequency in all groups on admissions, with orthopedic surgery being the most common operation (31.0% ICD vs 35.3% PM vs 29.5%ND, p=ns). ICD patients had significantly more frequent NTDS defined complications (38.6%) than no device patients (29.6%^), but not compared to PM (33.8%, p=ns). Significantly fewer ICD were discharged to home as compared to no device patients (24.8% vs 38.8%^), but not as compared to PM patients (31.2%, p=ns). Significantly more ICD patients were discharged to acute rehabilitation as compared to no device patients (52.4% vs 44.2%^), but not as compared to PM patients (42.3%). Patients with ICDs had significantly higher mortality (12.4%# versus 9% in PM and 5.6%*,^ in ND group). However, in multivariate logistic regression, ICDs and pacemakers were not independent predictors of in-hospital mortality.
Conclusion: To our knowledge, this is the first report on the prevalence and outcomes of ICDs and PMs in the trauma population. We noted a substantial presence (9%) of PMs or ICDs in geriatric trauma patients. Over 1/3 of cardiac device patients developed complications during hospitalization and more than 10% expired expire during the index hospitalization, despite sustaining low energy trauma, predominantly low-level falls, and having low injury severity scores. Few survived to discharge home. The overall in-hospital mortality rate of cardiac device patients was double the ND rate. Greater vigilance is suggested in the triage and management of patients with ICDs or PMs, as these devices are markers of adverse outcomes following trauma.
