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Echocardiogram Utilization Patterns and Association With Mortality Following Severe Traumatic Brain Injury.

Publication ,  Journal Article
Chen, F; Komisarow, JM; Mills, B; Vavilala, M; Hernandez, A; Laskowitz, DT; Mathew, JP; James, ML; Haines, KL; Raghunathan, K; Fuller, M ...
Published in: Anesth Analg
April 1, 2021

BACKGROUND: Severe traumatic brain injury (TBI) can result in left ventricular dysfunction, which can lead to hypotension and secondary brain injuries. Although echocardiography is often used to examine cardiovascular function in multiple clinical settings, its use and association with outcomes following severe TBI are 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. METHODS: A retrospective cohort study was conducted using a large administrative trauma registry maintained by the NTDB from 2007 to 2014. Patients >18 years with isolated severe TBI, 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. RESULTS: Among 47,808 patients, echocardiogram was utilized as part of clinical care in 2548 patients (5.3%). Clinical factors including vascular comorbidities and hemodynamic instability were associated with increased use of echocardiograms. Nearly half (46.0%, 95% confidence interval [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 odds ratio [OR] = 0.77; 95% CI, 0.69-0.87; P < .001). CONCLUSIONS: 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.

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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

April 1, 2021

Volume

132

Issue

4

Start / End Page

1060 / 1066

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Prognosis
  • Predictive Value of Tests
  • Middle Aged
  • Male
 

Citation

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Chen, F., Komisarow, J. M., Mills, B., Vavilala, M., Hernandez, A., Laskowitz, D. T., … Krishnamoorthy, V. (2021). Echocardiogram Utilization Patterns and Association With Mortality Following Severe Traumatic Brain Injury. Anesth Analg, 132(4), 1060–1066. https://doi.org/10.1213/ANE.0000000000005110
Chen, Fangyu, Jordan M. Komisarow, Brianna Mills, Monica Vavilala, Adrian Hernandez, Daniel T. Laskowitz, Joseph P. Mathew, et al. “Echocardiogram Utilization Patterns and Association With Mortality Following Severe Traumatic Brain Injury.Anesth Analg 132, no. 4 (April 1, 2021): 1060–66. https://doi.org/10.1213/ANE.0000000000005110.
Chen F, Komisarow JM, Mills B, Vavilala M, Hernandez A, Laskowitz DT, et al. Echocardiogram Utilization Patterns and Association With Mortality Following Severe Traumatic Brain Injury. Anesth Analg. 2021 Apr 1;132(4):1060–6.
Chen, Fangyu, et al. “Echocardiogram Utilization Patterns and Association With Mortality Following Severe Traumatic Brain Injury.Anesth Analg, vol. 132, no. 4, Apr. 2021, pp. 1060–66. Pubmed, doi:10.1213/ANE.0000000000005110.
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. Echocardiogram Utilization Patterns and Association With Mortality Following Severe Traumatic Brain Injury. Anesth Analg. 2021 Apr 1;132(4):1060–1066.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

April 1, 2021

Volume

132

Issue

4

Start / End Page

1060 / 1066

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Prognosis
  • Predictive Value of Tests
  • Middle Aged
  • Male