Atrial fibrillation in trauma patients requiring intensive care.
OBJECTIVE
To evaluate the incidence and risk factors of atrial fibrillation (AF) in trauma patients.


METHODS
Prospective observational study in a surgical intensive care unit (ICU).


METHODS
All trauma patients admitted in the surgical ICU except those who had AF at admission.


RESULTS
AF occurred in 16/293 patients (5.5%). AF patients were older, had a higher number of regions traumatized, and received more fluid therapy, transfusion products, and catecholamines. They more frequently experienced systemic inflammatory response syndrome, sepsis, shock, and acute renal failure and had higher scores of severity (Simplified Acute Physiology Score, SAPS II; Injury Severity Score). ICU length of stay and resources use were also increased. ICU and hospital mortality rates were twice higher in AF patients whereas standardized mortality ratio (observed/expected mortality by SAPS II) was similar in the two groups. We found five independent risk factors of developing AF: catecholamine use (OR = 5.7, 95% CI 1.7-19.1), SAPS II of 30 or higher (OR = 11.6, 95% CI 1.3-103.0), three or more regions traumatized (OR = 6.2, 95% CI 1.8-21.4), age 40 years or higher (OR = 6.3, CI 1.4-28.7), and systemic inflammatory response syndrome (OR = 4.4, 95% CI 1.2-16.1).


CONCLUSIONS
In addition to age and catecholamine use, inflammation and severity of injury may be involved in the development of AF in trauma patients. Our results suggest that AF could rather be a marker of a higher severity of illness without major effect on mortality.
Hôpital Pontchaillou, Surgical Intensive Care Unit, 2 rue Henri le Guilloux, Rennes Cedex 9, 35033 Rennes, France. philippe.seguin@chu-rennes.fr
Philippe
P
Seguin
Bruno
B
Laviolle
Axelle
A
Maurice
Christophe
C
Leclercq
Yannick
Y
Mallédant
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology*; D003422:Critical Care / Q000458:organization & administration; D005602:France / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014947:Wounds and Injuries