“Smoker’s Paradox” in Patients Treated for Severe Injuries: Lower Risk of Mortality After Trauma Observed in Current Smokers

Bell, Teresa M.; Bayt, Demetria R.; Zarzaur, Ben L.

doi:10.1093/ntr/ntv027

Cited by 12 publications

(15 citation statements)

References 39 publications

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“…Furthermore, it has been described that smoking might significantly reduce the number of complications and mortality in severely injured patients, which is known as the 'smoker's paradox'. 19 Similar outcomes have been described among patients with cardiovascular disease. 20 However, the potential protective mechanisms behind this phenomenon and its clinical implications are not well established.…”

Section: Open Accesssupporting

confidence: 58%

Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank

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Saillant

et al. 2020

Trauma Surg Acute Care Open

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BackgroundIn recent years, there has been increasing interest in the treatment of patients with rib fractures. However, the current literature on the epidemiology and outcomes of rib fractures is outdated and inconsistent. Furthermore, although it has been suggested that there is a large heterogeneity among patients with traumatic rib fractures, there is insufficient literature reporting on the outcomes of different subgroups.MethodsA retrospective cohort study using the National Trauma Data Bank was performed. All adult patients with one or more traumatic rib fractures or flail chest who were admitted to a hospital between January 2010 and December 2016 were identified by the International Classification of Diseases Ninth Revision diagnostic codes.ResultsOf the 564 798 included patients with one or more rib fractures, 44.9% (n=2 53 564) were patients with polytrauma. Two per cent had open rib fractures (n=11 433, 2.0%) and flail chest was found in 4% (n=23 388, 4.1%) of all cases. Motor vehicle accidents (n=237 995, 51.6%) were the most common cause of rib fractures in patients with polytrauma and flail chest. Blunt chest injury accounted for 95.5% (n=5 39 422) of rib fractures. Rib fractures in elderly patients were predominantly caused by high and low energy falls (n=67 675, 51.9%). Ultimately, 49.5% (n=2 79 615) of all patients were admitted to an intensive care unit, of whom a quarter (n=146 191, 25.9%) required invasive mechanical ventilatory support. The overall mortality rate was 5.6% (n=31 524).DiscussionTraumatic rib fractures are a marker of severe injury as approximately half of patients were patients with polytrauma. Furthermore, patients with rib fractures are a very heterogeneous group with a considerable difference in epidemiology, injury characteristics and in-hospital outcomes. Worse outcomes were predominantly observed among patients with polytrauma and flail chest. Future studies should recognize these differences and treatment should be evaluated accordingly.Level of evidenceII/III.

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Section: Open Accesssupporting

confidence: 58%

Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank

Peek

Ochen

Saillant

et al. 2020

Trauma Surg Acute Care Open

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“…The protective effect we found on short-term outcomes post AMI could also be similar to the “smoker’s paradox,” referring to the observed short-term mortality benefit in tobacco users post AMI [ 16 , 17 ]. Several studies over the past 20 years have described a mortality benefit conferred in tobacco users in the 30-day period post AMI, especially with use of thrombolytic therapy for treatment [ 18 , 19 ].…”

Section: Discussionsupporting

confidence: 70%

Marijuana use and short-term outcomes in patients hospitalized for acute myocardial infarction

et al. 2018

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Marijuana use is increasing worldwide, and it is ever more likely that patients presenting with acute myocardial infarctions (AMI) will be marijuana users. However, little is known about the impact of marijuana use on short-term outcomes following AMI. Accordingly, we compared in-hospital outcomes of AMI patients with reported marijuana use to those with no reported marijuana use. We hypothesized that marijuana use would be associated with increased risk of adverse outcomes in AMI patients. Hospital records from 8 states between 1994–2013 were screened for patients with a diagnosis of AMI. Clinical profiles and outcomes in patients with reported use of marijuana were compared to patients without reported marijuana use. Short-term outcomes were defined as adverse events that occurred during hospitalization for an admitting diagnosis of AMI. The composite primary outcome included death, intraaortic balloon pump placement, (IABP), mechanical ventilation, cardiac arrest, and shock. In total, 3,854 of 1,273,897 AMI patients reported use of marijuana. The marijuana cohort was younger than (47.2 vs. 57.2, respectively) and had less coronary artery disease than the non-marijuana cohort. In multivariable analysis including age, race and common cardiac risk factors, there was no association between marijuana use and the primary outcome (p = 0.53), but marijuana users were more likely to be placed on mechanical ventilation (OR (odds ratio) 1.19, p = 0.004). Interestingly, marijuana-using patients were significantly less likely to die (OR 0.79, p = 0.016), experience shock (OR 0.74, p = 0.001), or require an IABP (OR 0.80, p = 0.03) post AMI than patients with no reported marijuana use. These results suggest that, contrary to our hypothesis, marijuana use was not associated with increased risk of adverse short-term outcomes following AMI. Furthermore, marijuana use was associated with decreased in-hospital mortality post-AMI.

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“…Trauma patients who smoke do not consistently have worse outcomes compared to non-smokers [41]. In fact, several studies have demonstrated a lower mortality in adult smokers following a traumatic injury [38,42,43]. This phenomenon is termed the "smoker's paradox," and was originally described in adult patients who sustained acute myocardial infarction [44][45][46].…”

Section: Discussionmentioning

confidence: 99%

The effects of smoking on adolescent trauma patients: a propensity-score-matched analysis

et al. 2020

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Purpose Cigarettes have been demonstrated to be toxic to the pulmonary connective tissue by impairing the lung's ability to clear debris, resulting in infection and acute respiratory distress syndrome (ARDS). Approximately 8% of adolescents are smokers. We hypothesized that adolescent trauma patients who smoke have a higher rate of ARDS and pneumonia when compared to non-smokers. Methods The Trauma Quality Improvement Program (2014-2016) was queried for adolescent trauma patients aged 13-17 years. Adolescent smokers were 1:2 propensity-score-matched to non-smokers based on age, comorbidities, and injury type. Data were analyzed using chi square for categorical data and Mann-Whitney U test for continuous data. Results From 32,610 adolescent patients, 997 (3.1%) were smokers. After matching, 459 smokers were compared to 918 non-smokers. There were no differences in matched characteristics. Compared to non-smokers, smokers had an increased rate of pneumonia (3.1% vs. 1.1%, p = 0.01) but not ARDS (0.2% vs. 0%, p = 0.16). Compared to the non-smoking group, the smokers had a longer median total hospital length-of-stay (3 vs. 2 days, p = 0.01) and no difference in overall mortality (1.5% vs. 2.4%, p = 0.29). Conclusion Smoking is associated with an increased rate of pneumonia in adolescent trauma patients. Future research should target smoking cessation and/or interventions to mitigate the deleterious effects of smoking in this population.

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“Smoker’s Paradox” in Patients Treated for Severe Injuries: Lower Risk of Mortality After Trauma Observed in Current Smokers

Abstract: Patients who smoke appear to have a much lower risk of in-hospital mortality than nonsmokers. Further investigation into biological mechanisms responsible for this effect should be carried out in order to potentially develop therapeutic applications.

Cited by 12 publications

References 39 publications

Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank

Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank

Marijuana use and short-term outcomes in patients hospitalized for acute myocardial infarction

The effects of smoking on adolescent trauma patients: a propensity-score-matched analysis

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