Examining the influence of blood alcohol level on the incidence of pneumonia & sepsis complications following traumatic injury

Postinjury Sepsis-Associations With Risk Factors, Impact on Clinical Course, and Mortality: A Retrospective Observational Study

OBJECTIVES

Overall outcomes for trauma patients have improved over time. However, mortality for postinjury sepsis has been reported to be unchanged. Estimate incidence of and risk factors for sepsis in ICU patients after major trauma and the association between sepsis, mortality, and clinical course.

DESIGN SETTING AND PATIENTS

ICU in a large urban trauma center in Sweden with a well-developed trauma system. Retrospective cohort study of trauma patients admitted to the ICU for more than 24 hours were included.

MEASUREMENTS AND MAIN RESULTS

Primary outcome measure was 30-day mortality. Secondary outcomes were 1-year mortality and impact on clinical course. In total, 722 patients with a median Injury Severity Score of 26 (interquartile range, 18-38) were included. Incidence of sepsis was 22%. Septic patients had a four-fold increase in length of stay and need for organ supportive therapy. The overall 30-day mortality rate was 9.3%. After exclusion of early trauma-related deaths in the first 48 hours, the 30-day mortality rate was 6.7%. There was an association between sepsis and this adjusted 30-day mortality (day 3 odds ratio, 2.1 [95% CI, 1.1-3.9]; day 4 odds ratio, 3.1 [95% CI, 1.5-6.1]; day 5 odds ratio, 3.0 [95% CI, 1.4-6.2]). Septic patients had a 1-year mortality of 17.7% (nonseptic 11.0%). Development of sepsis was independently associated with age, spine and chest injury, shock, red cell transfusion, and positive blood alcohol concentration at admission. The risk of sepsis increased, in a dose-dependent manner, with the number of transfusions.

CONCLUSIONS

Postinjury sepsis was associated with a complicated clinical course and with mortality after exclusion of early, trauma-related deaths.

Prolonged Prehospital Time is a Risk Factor for Pneumonia in Trauma (the PRE-TRIP study): A Retrospective Analysis of the United States National Trauma Data Bank

BACKGROUND

Although multiple risk factors for development of pneumonia in patients with trauma sustained in a motor vehicle accident have been studied, the effect of prehospital time on pneumonia incidence post-trauma is unknown.

RESEARCH QUESTION

Is prolonged prehospital time an independent risk factor for pneumonia?

STUDY DESIGN AND METHODS

We retrospectively analyzed prospectively collected clinical data from 806,012 motor vehicle accident trauma incidents from the roughly 750 trauma hospitals contributing data to the National Trauma Data Bank between 2010 and 2016.

RESULTS

Prehospital time was independently associated with development of pneumonia post-motor vehicle trauma (p < 0.001). This association was primarily driven by patients with low Glasgow Coma Scale scores. Post-trauma pneumonia was uncommon (1.5% incidence) but was associated with a significant increase in mortality (p < 0.001, 4.3% mortality without pneumonia vs. 12.1% mortality with pneumonia). Other pneumonia risk factors included age, sex, race, primary payor, trauma center teaching status, bed size, geographic region, intoxication, comorbid lung disease, steroid use, lower Glasgow Coma Scale score, higher Injury Severity Scale score, blood product transfusion, chest trauma, and respiratory burns.

INTERPRETATION

Increased prehospital time is an independent risk factor for development of pneumonia and increased mortality in patients with trauma caused by a motor vehicle accident. Although prehospital time is often not modifiable, its recognition as a pneumonia risk factor is important as prolonged prehospital time may need to be considered in subsequent decision making.

CLINICAL TRIAL REGISTRATION

Not applicable.

Epidemiology and Impact of Healthcare-Associated Infections in Trauma Patients: A National Data Analysis

Background: Traumatic injuries are a leading cause of death and morbidity. Despite their comprising a small (<5%) segment of all hospitalizations, the length of stay (LOS) is above average; and the cost of care for the more than 20 million trauma inpatients nears $30 billion per year. Adding insult to injury, risk factors for health-care-associated infections (HAI), including invasive devices and comprised integrity, may be particularly pronounced in this population, potentially exacerbating the clinical and economic burden. Our aim was to determine the distribution, determinants, and burden of HAI after traumatic injury using LOS as a surrogate for health-care-related expense. Patients and Methods: This retrospective cohort study used the Trauma Quality Improvement Project (TQIP) database (2013-2016). Patients 16 to 89 years of age were included. Those who developed at least one of the following were counted as cases: Catheter-related central blood stream infection, catheter-related urinary tract infection, ventilator-associated pneumonia, surgical site infection, osteomyelitis, and severe sepsis. Outcomes included the hospital LOS, intensive care unit (ICU) days, and ventilator days. Uni-variable and propensity-matched analyses were conducted to determine differences among patients with and without an HAI. Results: Of 806,066 patients, 5.6% (n = 44,844) developed an HAI. A higher proportion of patients with HAI had co-morbid risk factors of chronicity and history of blood transfusion and rated higher on the Abbreviated Injury Scale than those without HAI. After matching, those with HAI also had significantly longer (3 × ) overall LOS, ICU LOS, and prolonged mechanical ventilation (p < 0.05). Conclusions: This updated epidemiology study of trauma patients showed the HAI burden to be higher than past estimates and disproportionate of all patient estimates. The associated economic burden of a longer ICU stay with a tripling of the LOS and longer mechanical ventilation demands responsible administrative policies and support for infection prevention programs and interventions.