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Heldreth AC, Demissie S, Pandya S, Baker M, Gallagher A, Copty M, Azab B, Moko L, Atanassov K, Gave A, Shimotake L, Glinik G, Gross J, Younan D. Stress-Induced (Not Diabetic) Hyperglycemia is Associated With Mortality in Geriatric Trauma Patients. J Surg Res 2023; 289:247-252. [PMID: 37150079 DOI: 10.1016/j.jss.2023.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 01/31/2023] [Accepted: 02/19/2023] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Stress-induced hyperglycemia (SIH) is associated with worse outcomes among trauma patients. It is also known that injured geriatric patients have higher mortality when compared to younger patients. We sought to investigate the association of all levels of SIH with mortality among geriatric trauma patients at a level 1 academic trauma center. We hypothesized that SIH in the geriatric trauma population would be associated with increased mortality. METHODS A retrospective review of all geriatric patients admitted to our level 1 trauma center over a 3-year period (January 2018-December 2020) was performed using the institutional trauma database. Data collected included demographics, injury severity score (ISS), emergency department (ED) blood glucose level, ED systolic blood pressure (SBP), and mortality. Patients were divided into 4 groups based on emergency room blood glucose level, as follows: normoglycemic (<120 mg/dL), mild hyperglycemia (120-150 mg/dL), moderate hyperglycemia (151-199 mg/dL), and severe hyperglycemia (≥200 mg/dL). Multivariable logistic regression analysis was performed to evaluate the association of SIH and in-hospital mortality adjusting for ISS, age, comorbidities, and ED SBP. RESULTS A total of 4432 geriatric trauma patients were admitted during the study period, of which 3358 patients (75.8%) were not diabetic. There were 2206 females (65.7%), 2993 were White (89.2%), with a mean age of 81.5 y. There were 114 deaths (3.4%). Univariate results showed that there was a statistically significant association between mortality and glucose groups (P < 0.01). The number of deaths in the four glucose groups were, as follows: 30 (2.0%), 32 (3.8%), 20 (6.2%), and 10 (12.2%), respectively. Multivariable logistic regression analysis results showed that compared to the normoglycemic group, the risk of death was higher in the mild, moderate, and severe glucose groups, as follows: mild group (OR 1.80, 95% confidence interval [CI] 1.04-3.13, P 0.04), moderate group (OR 2.53, 95% CI 1.34-4.80, P < 0.01), and severe group (OR 5.04, 95% CI 2.18-11.67, P < 0.01). CONCLUSIONS Mild, moderate, and severe SIH are statistically significant predictors of death among geriatric trauma patients independently of ISS, age, comorbidities, and SBP.
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Affiliation(s)
- Audrey C Heldreth
- Division of Acute Care Surgery, The Department of Surgery, Staten Island University Hospital, Staten Island, New York.
| | - Seleshi Demissie
- Biostatistics Unit, Feinstein Institutes for Medical Research, Staten Island University Hospital, Staten Island, New York
| | - Shreya Pandya
- Division of Acute Care Surgery, The Department of Surgery, Staten Island University Hospital, Staten Island, New York
| | - Matthew Baker
- Division of Acute Care Surgery, The Department of Surgery, Staten Island University Hospital, Staten Island, New York
| | - Alayna Gallagher
- Division of Acute Care Surgery, The Department of Surgery, Staten Island University Hospital, Staten Island, New York
| | - Michael Copty
- Division of Acute Care Surgery, The Department of Surgery, Staten Island University Hospital, Staten Island, New York
| | - Basem Azab
- Division of Surgical Oncology, Department of Surgery, Staten Island University Hospital, Staten Island, New York
| | - Lilamarie Moko
- Division of Acute Care Surgery, The Department of Surgery, Staten Island University Hospital, Staten Island, New York
| | - Krassimir Atanassov
- Division of Acute Care Surgery, The Department of Surgery, Staten Island University Hospital, Staten Island, New York
| | - Asaf Gave
- Division of Acute Care Surgery, The Department of Surgery, Staten Island University Hospital, Staten Island, New York
| | - Lisa Shimotake
- Division of Minimally Invasive Surgery, Department of Surgery, Staten Island University Hospital, Staten Island, New York
| | - Galina Glinik
- Division of Acute Care Surgery, The Department of Surgery, Staten Island University Hospital, Staten Island, New York
| | - Jonathan Gross
- Division of Orthopedic Surgery, Department of Surgery, Staten Island University Hospital, Staten Island, New York
| | - Duraid Younan
- Division of Acute Care Surgery, The Department of Surgery, Staten Island University Hospital, Staten Island, New York
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Gross DJ, Shimotake L, Boudourakis L. Progressive Acute Abdominal Pain. JAMA Surg 2017; 152:1173-1174. [PMID: 29049610 DOI: 10.1001/jamasurg.2017.3838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Daniel J Gross
- Department of Surgery, State University of New York University Hospital of Brooklyn
| | - Lisa Shimotake
- Department of Surgery, State University of New York University Hospital of Brooklyn
| | - Leon Boudourakis
- Department of Surgery, Kings County Medical Center, Brooklyn, New York
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Abstract
Among the pediatric population malrotation is the most common cause of volvulus. This paper describes a case of adult malrotation, which progressed to volvulus shortly after appendectomy. It also reviews clinical presentations and diagnostic tools, discusses the recommended management, and considerations when addressing of this rare malady.
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Affiliation(s)
- Johanna Basa
- Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Lisa Shimotake
- Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - Boyoung Song
- Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
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