J. M. Kennedy1, A. Heldreth1, J. Doran1, P. Rivera1, V. Kaykaty1, D. Younan1 1Staten Island University Hospital, Department Of Surgery, Division Of Acute Care Surgery, Staten Island, NY, USA
Introduction: Age is associated with increased morbidity and mortality in trauma patients. Elevated heart rate (HR) in the trauma bay can be associated with hemodynamic changes in severely injured patients. Acute kidney injury (AKI) associated with trauma is usually multifactorial. We sought to investigate the impact high heart rate in the emergency department in mildly injured geriatric patients has on kidney function.
Methods: A retrospective review of the trauma database identified geriatric patients (age >64 years) who were admitted between January 2018 and July 2022 at our institution. The primary outcome measure was AKI. Patients were divided based on heart rate in the emergency department into 2 groups (<120, >120). Demographic, clinical, and outcome measures including injury severity score (ISS), comorbidities, age, and emergency department systolic blood pressure (SBP) were analyzed. Patients with chronic renal failure were excluded from the analysis. Multivariate logistic regression analysis was performed for the association of HR and AKI.
Results: 4947 geriatric patients (age >65 years) were admitted to our level 1 trauma center as a trauma activation. There were 1785 men (36.1%) and 4296 (86.8%) were white, median ISS was 5. Significant differences were noted between the two groups in ISS (p<.01), SBP (p<.01), hematocrit level (p=0.01), and AKI (p<.01). Multivariate logistic regression analysis showed heart rate more than 120 beats per minute (p<.01), injury severity score (ISS) (p<.01) and past medical history (PMH) to be independently predictive of developing AKI while Systolic Blood Pressure (p=0.18) and age (p=0.83) were not.
Conclusion: Heart rate greater than 120 bpm in the emergency department is an independent predictor of AKI among mildly injured geriatric trauma patients.