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Bhuiya T, Omeh D, Munshi R, Berookhim B, Roper A, Vilcant V, Syzdziak E, Hai O, Zeltser R, Digiacomo J, Makaryus AN. Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries. Trauma Surg Acute Care Open 2023; 8:e001053. [PMID: 37342816 PMCID: PMC10277545 DOI: 10.1136/tsaco-2022-001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/26/2023] [Indexed: 06/23/2023] Open
Abstract
Background The presence of permanent pacemakers (PPM) is common among the elderly population. Trauma literature has shown that the inability to augment cardiac output by at least 30% after injury portends a higher mortality. The presence of a PPM may be a surrogate marker to identify patients who are unable to increase cardiac output. We aimed to evaluate the association between the presence of PPM and clinical outcomes in elderly patients presenting with traumatic injuries. Methods A total of 4505 patients aged ≥65 years admitted with acute trauma from 2009 to 2019 at our Level I Trauma center were evaluated and stratified into two groups using propensity matching on age, sex, injury severity score (ISS), and year of admission based on the presence of PPM. Logistic regression was performed to analyze the impact of the presence of PPM on mortality, surgical intensive care unit (SICU) admission, operative intervention, and length of stay. Prevalence of cardiovascular comorbidities was compared using χ2 analysis. Results Data from 208 patients with PPM and 208 propensity-matched controls were evaluated. Charlson Comorbidity Index, mechanism of injury, intensive care unit admission, and rate of operative intervention were comparable in the two groups. PPM patients had more coronary artery disease (p=0.04), heart failure with reduced ejection fraction (p=0.003), atrial fibrillation (AF, p<0.0001), and antithrombotic use (p<0.0001). We found no association between mortality amongst the groups after controlling for influencing variables (OR=2.1 (0.97 to 4.74), p=0.061). Patient characteristics associated with survival included female sex (p=0.009), lower ISS (p<0.0001), lower revised trauma score (p<0.0001), and lower SICU admission (p=0.001). Conclusion Our study shows no association between mortality among patients with PPM admitted for treatment of trauma. Presence of a PPM may be an indicator of cardiovascular disease, but this does not translate into increased risk in the modern era of trauma management in our patient population. Level of evidence Level III.
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Affiliation(s)
- Tanzim Bhuiya
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Demian Omeh
- Cardiology, Nassau University Medical Center, East Meadow, New York, USA
| | - Rezwan Munshi
- Cardiology, Nassau University Medical Center, East Meadow, New York, USA
| | - Brian Berookhim
- Cardiology, Nassau University Medical Center, East Meadow, New York, USA
| | - Ashley Roper
- Cardiology, Nassau University Medical Center, East Meadow, New York, USA
| | - Viliane Vilcant
- Cardiology, Nassau University Medical Center, East Meadow, New York, USA
| | - Elisa Syzdziak
- Surgery, Nassau University Medical Center, East Meadow, New York, USA
| | - Ofek Hai
- Cardiology, Nassau University Medical Center, East Meadow, New York, USA
| | - Roman Zeltser
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Cardiology, Nassau University Medical Center, East Meadow, New York, USA
| | - Jody Digiacomo
- Surgery, Nassau University Medical Center, East Meadow, New York, USA
| | - Amgad N Makaryus
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Cardiology, Nassau University Medical Center, East Meadow, New York, USA
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Hernandez NS, Kanter M, Sharma V, Wang A, Kiernan M, Kryzanski D, Heller R, Nail T, Riesenburger RI, Kryzanski JT. Radiographic risk factors for intracranial hemorrhage in patients with left ventricular assist devices. J Stroke Cerebrovasc Dis 2022; 31:106869. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022] Open
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Cardiac Implantable Electric Devices: Indications and Complications. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40138-017-0128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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