N a t i o n a l a n d K a p o d i s t r i a n U n i v e r s i t y, M e d i c a l S c h o o l ,F i r s t C r i t i c a l C a r e D e p a r t m e n t , E v a n g e l i s m o s H o s p i t a l , A t h e n s , G r e e c e

Study Aims Results Conclusion

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Methods

EPIDEMIOLOGY AND EARLY DIAGNOSIS OF HETEROTOPIC OSSIFICATION IN CRITICAL

ILL PATIENTS. PRELIMINARY DATA

A. Christakou, M. Alimatiri, I. Patsaki, A. Kouvarakos, E. Papadopoulos, K. Stefanidis, D. Karakitsos, C.S. Vrettou, V. Markaki, S. Nanas

Background and Study Aims

• Acquired neurogenic heterotopic ossification (NHO) is a well-recognized condition in intensive care unit (ICU)

(Genet et al., 2011; Simonsen et al., 2007)

• It effects patients' mobility and morbidity, time of hospitalization and cost (Van Campen et al., 2011)

• The purpose of this study was to assess the role of joint mobility, pain and ultrasonography in early diagnosis in critical ill patients in a general ICU

Results ConclusionMethods

Methods 1.: Flow chart

85 consecutive patients discharged from the ICU

Inclusion criteria: - mechanical ventilation > 72h - age 18-75 years - length of stay in ICU at least 5 days

- not previous HO

45 patients were excluded & 25 patients were deceased

20 patients were eligible for the study

Methods 2.: Baseline characteristics (mean ± SD)

• 20 patients were evaluated (M:14,F:6) (age 51±16 years)• ICU stay (days) 20.0±13.6 • Mechanical ventilation (days) 13.4 ±10.1• Apache II admission score 15.7±6.2• Sofa admission score 6.9±2.1• GCS 9.1 ± 4.1

• The patients received weekly assessment of passive range of motion (pROM) of hip, knee, shoulder and elbow joints with a goniometry

• The pain during joint mobilization was evaluated by

Behavioral Pain Scale (BPS) (Payen et al., 2009) & numeric Visual Analogue Scale (VAS)

• An ultrasonography was performed in any clinically suspected patient

• Confirmation of NHO diagnosis by ultrasonography & radiography

Methods 3.: Assessment tools

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Results Conclusion

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Assessment of HO with goniometry

Confirmation of HO with X-Ray

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Results 1.: Incidence of NHO

• The incidence of NHO was 2 out of 20 cases (10%) with acquired brain injury

• NHO was located in the hip joint in one case and in the hip and elbow joints in the second case

The mean time of NHO diagnosis following their admission day in ICU was 10 ± 4 weeks

Conclusion

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(mean ± SD)

[Fig.1& 2]. [Fig.3& 4]. (mean ± SD)

Variables Mean±SD One sample t-test t (df), p value

pROM of Hip -3.96±8.93 t(19)= -2.00*, p= .05pROM of Knee -.17±.77 t(19)= -1.00, p= .33pROM of Elbow -1.36±3.00 t(19)= -2.03*, p= .05pROM of Shoulder -1.50±4.25 t(19)= -1.58, p= .13Shoulder pain 6.65±12.49 t(17)= 2.26*, p= .03Elbow pain 6.56±15.96 t(17)= 1.74, p= .09Hip pain 28.45±54.10 t(17)= 2.23*, p= .03Knee pain 6.93±15.88 t(17)= 1.85, p= .08

Figure 1 & 2. Histograms of % pROM hip and elbow joints

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Figure 3 & 4. Histograms of % pain of hip and shoulder joints

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• Heterotopic ossification is a common complication in the ICU

• Ultrasonography may play a pivotal diagnostic role in the identification and early detection of NHO

• Limitation was the relatively small number of critically ill patients

• Further studies are needed to determine a valid risk profile of a critical ill patient with HO for the administration of preventive measures

Conclusions

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