Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index

Abstract

Purpose Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients. Methods All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference. Results 259,399 patients met the study’s inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01–1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05–1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11–1.90), p = 0.006], compared to RCRI 0. Conclusion An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population.

Predictors of outcomes in geriatric patients with moderate traumatic brain injury after ground level falls

“… *Patients received one point for each of the following: a history of ischemic heart disease, congestive heart failure, cerebrovascular disease, diabetes mellitus, and renal insufficiency (acute kidney injury or chronic kidney disease) ( 14 , 15 ).TBI, Traumatic brain injury; GLF, Ground-level fall; RCRI, Revised Cardiac Risk Index; COPD, chronic obstructive pulmonary disease. …”

“…The RCRI relies on six objective data points that can be readily obtained during admission without requiring invasive tests. Early identification of high-risk patients using the RCRI can facilitate appropriate allocation of resources and expertise, ensuring that patients receive the most suitable and timely interventions ( 14 , 15 , 36 ).…”

“…A logistic regression (LR) model was fitted, with in-hospital complications as the outcome variable and age, sex, injury severity score (ISS), highest AIS in each region, intracranial injuries, neurosurgical intervention, Revised Cardiac Risk Index (RCRI) ( 14 , 15 ), shock index, vitals on admission to the emergency room (systolic blood pressure, pulse rate, temperature, oxygen saturation, respiratory rate), Glasgow Coma Scale (GCS) on admission to the emergency room, as well as comorbidities (hypertension, history of peripheral vascular disease, functionally dependent health status, chronic obstructive pulmonary disease, smoking status, cirrhosis, coagulopathy, currently receiving chemotherapy for cancer, metastatic cancer, drug use disorder, alcohol use disorder, and major psychiatric illness) as the explanatory variables ( 16 – 18 ). Preadmission anticoagulant therapy was unable to be included as a covariate given over 38% of cases were missing these data.…”

Cardiac risk stratification and adverse outcomes in surgically managed patients with isolated traumatic spine injuries

“…The Revised Cardiac Risk Index (RCRI) is a tool traditionally used to predict the 30-day risk of postoperative myocardial infarction, cardiac arrest, and all-cause mortality [15,16]. The RCRI was determined using six dichotomous variables: previous ischemic heart disease, previous cerebrovascular disease, congestive heart failure, renal insufficiency (defined as chronic kidney disease or acute kidney injury), and high-risk surgery [17][18][19][20]. High-risk surgery is defined as any suprainguinal vascular surgery as well as intrathoracic and intraperitoneal surgery, according to the American College of Cardiology and American Heart Association [24].…”

“…The Revised Cardiac Risk Index (RCRI) is a risk stratification tool used to predict adverse outcomes within 30 days after noncardiac surgery [15,16]. It has been validated in various populations where higher RCRI scores have been associated with increased mortality and other adverse outcomes, including patients with severe traumatic brain injury [17]. rib fractures [18], and those with traumatic hip fractures [19,20].…”