Echocardiogram Utilization Patterns and Association With Mortality Following Severe Traumatic Brain Injury.
Echocardiogram Utilization Patterns and Association With Mortality Following Severe Traumatic Brain Injury.
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DOI：
10.1213/ane.0000000000005110
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发表时间：
2021-04-01
影响因子：
5.7
通讯作者：
Krishnamoorthy V
中科院分区：
文献类型：
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作者：
Chen F;Komisarow JM;Mills B;Vavilala M;Hernandez A;Laskowitz DT;Mathew JP;James ML;Haines KL;Raghunathan K;Fuller M;Bartz RR;Krishnamoorthy V
严重的创伤性脑损伤（TBI）可导致左心室功能障碍，从而导致低血压和继发性脑损伤。虽然超声心动图通常用于多种临床环境中检查心血管功能，但其用途及其与严重脑外伤后预后的关系尚不清楚。为了解决这一差距，我们使用国家创伤数据库（NTDB）来描述超声心动图的使用模式，并检查其与严重脑外伤后死亡率的关系。回顾性队列研究使用NTDB在2007年至2014年间维护的大型行政创伤登记处进行。年龄在18 - 65岁的孤立性严重创伤性脑损伤患者，无并发严重多发损伤，纳入研究。我们使用多变量logistic回归模型研究了超声心动图的使用模式（包括总体使用、使用相关因素和使用变化）以及超声心动图使用与医院死亡率的关系。在47808例患者中，2548例（5.3%）患者将超声心动图作为临床护理的一部分。包括血管合并症和血流动力学不稳定在内的临床因素与超声心动图的使用增加有关。近一半（46.0%,95% CI 40.3% - 51.7%）的超声心动图使用的变化是在个别医院层面上解释的，超出了患者和损伤因素。接受超声心动图检查与严重脑外伤后住院死亡率降低相关(校正OR 0.77 （95% CI 0.69 - 0.87, p<0.001）。严重脑外伤后超声心动图的使用率相对较低，在医院水平上的使用差异很大。与降低住院死亡率的关联表明，超声心动图获得的信息可能与改善患者预后有关，但需要进一步的前瞻性研究证实。
Severe traumatic brain injury (TBI) can result in left ventricular dysfunction, which can lead to hypotension and secondary brain injuries. While echocardiography is often used to examine cardiovascular function in multiple clinical settings, its use and association with outcomes following severe TBI is not known. To address this gap, we used the National Trauma Data Bank (NTDB) to describe utilization patterns of echocardiography and examine its association with mortality following severe TBI. A retrospective cohort study was conducted using a large administrative trauma registry maintained by the NTDB from 2007 to 2014. Patients aged 18 to 65 with isolated severe traumatic brain injury, and without concurrent severe polytrauma, were included in the study. We examined echocardiogram utilization patterns (including overall utilization, factors associated with utilization, and variation in utilization) and the association of echocardiography utilization with hospital mortality, using multivariable logistic regression models. Among 47,808 patients, echocardiogram was utilized as part of clinical care in 2,548 (5.3%) patients. Clinical factors including vascular comorbidities and hemodynamic instability were associated with increased use of echocardiograms. Nearly half (46.0%, 95% CI 40.3% - 51.7%) of the variation in echocardiogram utilization was explained at the individual hospital level, above and beyond patient and injury factors. Exposure to an echocardiogram was associated with decreased odds of in-hospital mortality following severe TBI (adjusted OR 0.77 (95% CI 0.69 – 0.87, p<0.001). Echocardiogram utilization following severe TBI is relatively low, with wide variation in use at the hospital level. The association with decreased in-hospital mortality suggests that the information derived from echocardiography may be relevant to improving patient outcomes, but will require confirmation in further prospective studies.