Association of Angiotensin-Converting Enzyme Inhibitors with Increased Mortality Among Patients with Isolated Severe Traumatic Brain Injury.

BACKGROUND: Traumatic brain injury (TBI) is associated with one-third of all deaths from trauma. Preinjury exposure to cardiovascular drugs may affect TBI outcomes. Angiotensin-converting enzyme inhibitors (ACEIs) exacerbate brain cell damage and worsen functional outcomes in the laboratory setting. ß-blockers (BBs), however, appear to be associated with reduced mortality among patients with isolated TBI. OBJECTIVE: Examine the association between preinjury ACEI and BB use and clinical outcome among patients with isolated TBI. METHODS: A retrospective cohort study of patients age ≥ 40 years admitted to an academic level 1 trauma center with isolated TBI between January 2010 and December 2014 was performed. Isolated TBI was defined as a head Abbreviated Injury Scale (AIS) score ≥ 3, with chest, abdomen, and extremity AIS scores ≤ 2. Preinjury medication use was determined through chart review. All patients with concurrent BB use were initially excluded. In-hospital mortality was the primary measured outcome. RESULTS: Over the 5-year study period, 600 patients were identified with isolated TBI who were naive to BB use. There was significantly higher mortality (P = .04) among patients who received ACEI before injury (10 of 96; 10%) than among those who did not (25 of 504; 5%). A multivariate stepwise logistic regression analysis revealed a threefold increased risk of mortality in the ACEI cohort (P < .001), which was even greater than the twofold increased risk of mortality associated with an Injury Severity Score ≥ 16. A second analysis that included patients who received preinjury BBs (n = 98) demonstrated slightly reduced mortality in the ACEI cohort with only a twofold increased risk in multivariate analysis (P = .05). CONCLUSIONS: Preinjury exposure to ACEIs is associated with an increase in mortality among patients with isolated TBI. This effect is ameliorated in patients who receive BBs, which provides evidence that this class of medications may provide a protective benefit.

Treadmill associated head injuries on the rise: an 18 year review of U.S. emergency room visits.

OBJECTIVE: The treadmill is the most commonly used aerobic exercise equipment with studies showing many gym-related injuries are attributed to treadmills. The purpose of this study is to examine the incidence of treadmill-associated head injuries within the US. METHODS: Retrospective data from 1997 to 2014 was collected via the National Electronic Injury Surveillance System, which provides annual es7timates of injuries associated with consumer products. Patients over 18 years who sustained treadmill-associated head injuries were included, and the estimated annual incidence was determined. RESULTS: An estimated 4929 patients presented to US emergency departments with a head injury while exercising on a treadmill between 1997 and 2014. A >1000% increase in the number of head injuries was observed over the study period (p-value <0.001). Patients over 50 had a 14 times greater risk of admission than younger patients (p-value <0.001). Injuries were greater in women than men. CONCLUSION: Our study demonstrates a significant increase treadmill-associated head injuries from 1997 to 2014. This phenomenon is most pronounced in older and female populations. The exact etiology of this large increase remains unclear. Education on the proper use of treadmills as well as further investigation into the cause of the increase are warranted.

Outcomes Among Malnourished Patients With Crohn's Disease Undergoing Elective Ileocecectomy: A Nationwide Analysis.

BACKGROUND: Crohn's patients' nutritional status can be suboptimal given disease pathophysiology; the effect of a malnourished state prior to elective surgery on post-operative outcomes remains to be more clearly elucidated. This study aims to characterize the effect of malnutrition on post-operative outcomes and readmission patterns for Crohn's patients undergoing elective ileocecectomy using a nationally representative cohort. METHODS: The colectomy-targeted National Surgical Quality Improvement Program Database (2016-2020) was used to identify patients with Crohn's disease without systemic complications who underwent elective ileocecectomy; emergency surgeries were excluded. Malnourished status was defined as pre-operative hypoalbuminemia <3.5 g/dL, weight loss >10% in 6 months, or body mass index <18.5 kg/m2 prior to surgery. RESULTS: Of 1464 patients (56% female) who met inclusion criteria, 1137 (78%) were well-nourished and 327 (22%) were malnourished. Post-operatively, malnourished patients had more organ space surgical site infections (SSI) (9% vs 4% nourished groups, P < .001) and more bleeding events requiring transfusion (9% vs 3% nourished, P < .001). 30-day unplanned readmission was higher in the malnourished group (14% vs 9% nourished, P = .032). Index admission length of stay was significantly longer in the malnourished group (4 days [3-7 days] vs the nourished cohort: 4 days [3-5 days], P < .001). DISCUSSION: Poor nutritional status is associated with organ space infections and bleeding as well as longer hospitalizations and more readmissions in Crohn's patients undergoing elective ileocecectomy. A detailed nutritional risk profile and nutritional optimization is important prior to elective surgery.

Pre-injury polypharmacy predicts mortality in isolated severe traumatic brain injury patients.

BACKGROUND: The use of 5 or more medications is defined as polypharmacy (PPM). The clinical impact of PPM on the isolated severe traumatic brain injury (TBI) patient has not been defined. METHODS: A retrospective cohort study was performed at our academic level 1 trauma center examining patients with isolated TBI. Pre-injury medications were reviewed, and inhospital mortality was the primary measured outcome. RESULTS: There were 698 patients with an isolated TBI over the 5-year study period; 177 (25.4%) patients reported pre-injury PPM. There were 18 (10.2%) deaths in the PPM cohort and 24 (4.6%) deaths in the non-PPM cohort (P < .0001). Stepwise logistic regression analysis revealed a 2.3 times greater risk of mortality in the PPM patients (P = .019). CONCLUSIONS: Pre-injury PPM increases mortality in patients with isolated severe TBI. This knowledge may provide opportunities for intervention in this population.