T. Syphan1, A. Mahajan2, L. Walden2, J. Goddard2, G. Yerneni1, I. Osman1, S. Pui1, Y. Hu1, H. McKillen3, G. Braybrooks1, A. Tran2, A. Tkacenko1, V. Shah1, V. Ho2, W. Baughman2, A. Aneja2, P. Ladha2 1Case Western Reserve University School Of Medicine, Cleveland, OH, USA 2MetroHealth Medical Center, Cleveland, OH, USA 3Northeast Ohio Medical University, Rootstown, OH, USA
Introduction:
Cardiac dysfunction (CD) in trauma patients is a significant factor that increases morbidity and mortality after trauma, but may remain undiagnosed in up to 20% of cases, delaying critical treatment. Undiagnosed CD may particularly be concerning in the older patient population as these patients may be more sensitive to complications. Our study aims to investigate the differences in undiagnosed CD between older adult and younger adult trauma patients.
Methods:
We retrospectively reviewed charts of adult trauma patients from 2022 to 2023 at a Level 1 trauma center who received an echocardiogram, excluding those with known CD. We used standard echo findings to define common types of cardiac dysfunction; Left ventricular dysfunction (LVD) was defined as LV EF ≤45% and right ventricular dysfunction (RVD) was defined as Tricuspid annular Plane Systolic Excursion (TAPSE) ≤17mm, Fractional Area Change (FAC) <35% or septal flattening/bowing. We identified trauma patients with previously undiagnosed CD, as well as the type of CD (isolated left ventricle, isolated right ventricle, or biventricular dysfunction). Patients were divided into older adult (aged 65 and older) and younger adult (aged less than 65) for comparison. We report medians with interquartile ranges, p-values, and the results of logistic regression analysis adjusted for demographic characteristics, comorbidities, and baseline renal function to assess factors associated with undiagnosed CD.
Results:
288 trauma patients were identified, of whom 54 patients with known CD were excluded. Of the remaining 234 patients, 142 (61%) were older (≥ 65 years) and 92 (39%) were younger, and 24 (10%) had previously undiagnosed CD. 11 (5%) had isolated RVD, 7 (3%) had isolated LVD and 6 (2%) had both. Although previously undiagnosed CD was more frequent in older trauma patients (13% vs. 7%), this was non-significant (p=0.1). Adjusted logistic regression showed that older patients had a higher odds of undiagnosed CD, though this was not significant (OR: 1.21 [1.00-1.45], p=0.08).
Conclusion:
Older trauma patients may be more likely to have previously undiagnosed CD compared to younger patients, although our study was likely underpowered to detect this difference. Further research must determine the extent to which age influences the likelihood of undiagnosed CD in trauma patients, and to identify potential strategies for early detection.