TACHYCARDIA WITHOUT HYPOTENSION IS A POOR PREDICTOR OF INTRA-ABDOMINAL PATHOLOGY IN TRAUMA PATIENTS
Zhobin Moghadamyeghaneh*1, Murwarit Rahimi2, Catherine Cuervo3, Anthony P Kopatsis4, Anthony Kopatsis1
1Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; 2The George Washington University School of Medicine and Health Sciences, Washington, ; 3St. George university, West Indies, Grenada; 4New York University, New York, NY
OBJECTIVE:
Trauma patients frequently undergo exploratory laparotomy due to a significant tachycardia without hypotension without any intra-abdominal pathology. This study aims to investigate associations between tachycardia and intra-abdominal pathology (bleeding or any other intra-abdominal injury requiring operation) in normotensive trauma patients.
METHODS:
Multivariate analysis using logistic regression was used to investigate associations between tachycardia (heart rate>100/min) and intra-abdominal pathology in trauma patients without hypotension (SBP>90 mm hg) using TQP database during 2016-2019.
RESULTS:
We found 6,362 level 1-3 trauma patients who were admitted to trauma bay without hypotension but with tachycardia and underwent emergent exploratory laparotomy within the database. Overall,1304 patients (20.5%) had negative laparotomy. There was not any association between tachycardia and intra-abdominal pathology (P=0.43). Patients without hypotension but with tachycardic>100, >120, >140, and >160 /min had negative laparotomy rates of 20.5%, 21.6%, 22%, and 27.9% respectively. The rate of negative laparotomy did not decrease with the increase in the heart rate (P=0.43).
Negative laparotomy was higher in elderly (32.7% for older than 80 years vs. 18.5% for younger than 40 years, P<0.01), alcohol intoxicated patients (22.1% vs. 20.3%, P<0.01), teaching hospitals compared to non-teaching hospitals (20.3% vs. 19%, P<0.01), and level one trauma patients (level one (20.7%) vs. level 3 (15%), P<0.01).
CONCLUSIONS:
Tachycardia in normotensive trauma patients is a confounding factor and it should not be used independently as a factor to assess the patient for exploratory laparotomy. Negative laparotomy is higher in older ages, alcohol intoxicated patients, teaching hospitals, and level one trauma patients.
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