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Bassi E, Merighi CT, Tomizuka CI, Guimarães T, Novo FDCF, Damous SHB, Utiyama EM, Malbouisson LMS. Association of antimicrobial use and incidence of hospital-acquired pneumonia in critically ill trauma patients with pulmonary contusion: an observational study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744454. [PMID: 37541487 PMCID: PMC11148494 DOI: 10.1016/j.bjane.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Pneumonia occurs in about 20% of trauma patients with pulmonary contusions. This study aims to evaluate the association between empirical antibiotic therapy and nosocomial pneumonia in this population. METHODS Retrospective cohort of adult patients admitted to a trauma-surgical ICU. The Antibiotic Therapy Group (ATG) was defined by intravenous antibiotic use for more than 48 h starting on hospital admission, while the Conservative Group (CG) was determined by antibiotic use no longer than 48 h. Primary outcome was microbiologically documented nosocomial pneumonia within 14 days after hospital admission. Logistic regression was used to estimate the association between group allocation and primary outcome. Exploratory analyses evaluating the association between resistant strains in pneumonia and antibiotic use were performed. RESULTS The study included 177 patients with chest trauma and pulmonary contusion on CT scan. ATG were more severely ill than CG, as shown by higher Injury Severity Score, SAPS3, SOFA score, higher rates, and longer duration of mechanical ventilation. In the multivariate analysis, ATG was associated with a lower incidence of primary outcome (OR = 0.25, 95% CI 0.09-0.64; p < 0.01). Similar results were found in the sensitivity analysis with another set of variables. However, each day of antibiotic use was associated with an increased risk of pneumonia by resistant bacteria (OR = 1.18 per day, 95% CI 1.05-1.36; p < 0.01). CONCLUSIONS Empiric antibiotic therapy was independently associated with lower incidence of nosocomial pneumonia in critically ill patients with pulmonary contusion. However, each day of antibiotic use was associated with increased resistant strains in infected patients.
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Affiliation(s)
- Estevão Bassi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil; Hospital Alemão Oswaldo Cruz, Unidade de Tratamento Intensivo, São Paulo, SP, Brazil.
| | - Camila Trevizani Merighi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil
| | - Carlos Issamu Tomizuka
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil
| | - Thais Guimarães
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Comissão de Controle de Infecção Hospitalar, São Paulo, SP, Brazil
| | - Fernando da Costa Ferreira Novo
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil
| | - Sergio Henrique Bastos Damous
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil
| | - Edivaldo Massazo Utiyama
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Divisão de Anestesiologia, São Paulo, SP, Brazil
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Burton KR, Magidson PD. Trauma (Excluding Falls) in the Older Adult. Clin Geriatr Med 2023; 39:519-533. [PMID: 37798063 DOI: 10.1016/j.cger.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Trauma in the older adult will increasingly become important to emergency physicians hoping to optimize their patient care. The geriatric patient population possesses higher rates of comorbidities that increase their risk for trauma and make their care more challenging. By considering the nuances that accompany the critical stabilization and injury-specific management of geriatric trauma patients, emergency physicians can decrease the prevalence of adverse outcomes.
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Affiliation(s)
- Kyle R Burton
- Department of Emergency Medicine, Johns Hopkins Hospital, 1830 Eas, Monument Street, Suite 6-110, Baltimore, MD 21287, USA
| | - Phillip D Magidson
- Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Suite A150, Baltimore, MD 21224, USA.
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Trabelsi B, Ghorbel S, Ben Rabeh R, Bouassida M, Ben Ali M. C-reactive protein in the early diagnosis of pneumonia complicating severe blunt chest trauma. LA TUNISIE MEDICALE 2023; 101:756-758. [PMID: 38465756 PMCID: PMC11261490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 03/12/2024]
Abstract
INTRODUCTION The early diagnosis of pneumonia following severe blunt chest trauma (SBCT) allows the early prescription of antibiotics and initiation of adequate supportive care. AIM To assess the usefulness of C-reactive protein (CRP) in the early diagnosis of pneumonia complicating SBCT. METHODS We conducted a prospective study of patients admitted to trauma intensive care unit for SBCT between January 2020 and February 2023. Patients were divided into two groups according to whether or not they developed pneumonia. The CRP levels were monitored daily. RESULTS One hundred sixty-seven patients were included. Pneumonia occurred in 40.1% of patients within a median of 5 days. We found statistically significant difference in mean CRP levels between groups from day 3 to day 9 following trauma. The increase in CRP level on the 4th day from a value greater than or equal to 192 mg/L was a marker of early diagnosis of pneumonia (sensitivity 80.6%; specificity 80.8%). CONCLUSION Daily CRP measurement from the 3rd day following SBCT may be useful for early diagnosis of pneumonia complicating SBCT.
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Affiliation(s)
- Becem Trabelsi
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Sahar Ghorbel
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Rania Ben Rabeh
- Pediatric Department C, Bechir Hamza Children's Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Mahdi Bouassida
- Department of Surgery, Taher Maamouri Teaching Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Mechaal Ben Ali
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
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Vollrath JT, Schindler CR, Herrmann E, Verboket RD, Henrich D, Marzi I, Störmann P. EVALUATION OF CYFRA 21-1, ANGIOPOETIN-2, PENTRAXIN-3, SRAGE, IL-6, AND IL-10 IN POLYTRAUMATIZED PATIENTS WITH CONCOMITANT THORACIC TRAUMA-HELPFUL MARKERS TO PREDICT PNEUMONIA? Shock 2023; 60:392-399. [PMID: 37548620 DOI: 10.1097/shk.0000000000002186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
ABSTRACT Background: Pneumonia is a frequent complication after polytrauma. This study aims to evaluate the ability of different serum markers to identify patients at risk of developing pneumonia after polytrauma. Methods: A retrospective analysis of prospectively collected data in polytraumatized patients with concomitant thoracic trauma (Injury Severity Score ≥16, Abbreviated Injury Scale Thorax ≥ 3) was performed. The study cohort was divided into patients with and without pneumonia during the clinical course. Serum levels of lung epithelial (CYFRA 21-1), endothelial (Ang-2), and inflammatory (PTX-3, sRAGE, IL-6, IL-10) markers were measured upon arrival in the trauma room and on days 2 and 5. Results: A total of 73 patients and 16 healthy controls were included in this study. Of these, 20 patients (27.4%) developed pneumonia. Polytraumatized patients showed significantly increased CYFRA 21-1 levels with a distinct peak after admission compared with healthy controls. Serum PTX-3 significantly increased on day 2 in polytraumatized patients compared with healthy controls. Injury Severity Score and demographic parameters were comparable between both groups (pneumonia vs. no pneumonia). No statistically significant difference could be observed for serum levels of CYFRA 21-1, Ang-2, PTX-3, sRAGE, IL-6, and IL-10 between the groups (pneumonia vs. no pneumonia) on all days. Logistic regression revealed a combination of IL-6, IL-10, sRAGE, and PTX-3 to be eventually helpful to identify patients at risk of developing pneumonia and our newly developed score was significantly higher on day 0 in patients developing pneumonia ( P < 0.05). Conclusion: The investigated serum markers alone are not helpful to identify polytraumatized patients at risk of developing pneumonia, while a combination of IL-6, IL-10, PTX-3, and sRAGE might be.
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Affiliation(s)
- Jan Tilmann Vollrath
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Frankfurt, Germany
| | - Cora Rebecca Schindler
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Frankfurt, Germany
| | - Eva Herrmann
- Institute for Biostatistics and Mathematical Modeling, Goethe University, Frankfurt, Germany
| | - René D Verboket
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Frankfurt, Germany
| | - Dirk Henrich
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Frankfurt, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Frankfurt, Germany
| | - Philipp Störmann
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Frankfurt, Germany
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Becker N, Hammen A, Bläsius F, Weber CD, Hildebrand F, Horst K. Effect of Injury Patterns on the Development of Complications and Trauma-Induced Mortality in Patients Suffering Multiple Trauma. J Clin Med 2023; 12:5111. [PMID: 37568511 PMCID: PMC10420136 DOI: 10.3390/jcm12155111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Patients that suffer from severe multiple trauma are highly vulnerable to the development of complications that influence their outcomes. Therefore, this study aimed to evaluate the risk factors that can facilitate an early recognition of adult patients at risk. The inclusion criteria were as follows: admission to a level 1 trauma center, injury severity score (ISS) ≥ 16 (severe injury was defined by an abbreviated injury score (AIS) ≥ 3) and ≥18 years of age. Injury- and patient-associated factors were correlated with the development of four complication clusters (surgery-related, infection, thromboembolic events and organ failure) and three mortality time points (immediate (6 h after admission), early (>6 h-72 h) and late (>72 h) mortality). Statistical analysis was performed using a Chi-square, Mann-Whitney U test, Cox hazard regression analysis and binominal logistic regression analysis. In total, 383 patients with a median ISS of 24 (interquartile range (IQR) 17-27) were included. The overall mortality rate (27.4%) peaked in the early mortality group. Lactate on admission significantly correlated with immediate and early mortality. Late mortality was significantly influenced by severe head injuries in patients with a moderate ISS (ISS 16-24). In patients with a high ISS (≥25), late mortality was influenced by a higher ISS, older age and higher rates of organ failure. Complications were observed in 47.5% of all patients, with infections being seen most often. The development of complications was significantly influenced by severe extremity injuries, the duration of mechanical ventilation and length of ICU stay. Infection remains the predominant posttraumatic complication. While immediate and early mortality is mainly influenced by the severity of the initial trauma, the rates of severe head injuries influence late mortality in moderate trauma severity, while organ failure remains a relevant factor in patients with a high injury severity.
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Affiliation(s)
- Nils Becker
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany; (N.B.)
| | - Antonia Hammen
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany; (N.B.)
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH University Hospital Aachen, 52074 Aachen, Germany
| | - Felix Bläsius
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany; (N.B.)
| | - Christian David Weber
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany; (N.B.)
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany; (N.B.)
| | - Klemens Horst
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany; (N.B.)
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Caceres E, Olivella JC, Yanez M, Viñan E, Estupiñan L, Boada N, Martin-Loeches I, Reyes LF. Risk factors and outcomes of lower respiratory tract infections after traumatic brain injury: a retrospective observational study. Front Med (Lausanne) 2023; 10:1077371. [PMID: 37138738 PMCID: PMC10150376 DOI: 10.3389/fmed.2023.1077371] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/22/2023] [Indexed: 05/05/2023] Open
Abstract
Background Traumatic brain injury (TBI) is a public health problem with a high burden in terms of disability and death. Infections are a common complication, with respiratory infections being the most frequent. Most available studies have addressed the impact of ventilator-associated pneumonia (VAP) after TBI; therefore, we aim to characterize the hospital impact of a broader entity, lower respiratory tract infections (LRTIs). Methods This observational, retrospective, single-center cohort study describes the clinical features and risk factors associated with LRTIs in patients with TBI admitted to an intensive care unit (ICU). We used bivariate and multivariate logistic regressions to identify the risk factors associated with developing LRTI and determine its impact on hospital mortality. Results We included 291 patients, of whom 77% (225/291) were men. The median (IQR) age was 38 years (28-52 years). The most common cause of injury was road traffic accidents 72% (210/291), followed by falls 18% (52/291) and assault at 3% (9/291). The median (IQR) Glasgow Coma Scale (GCS) score on admission was 9 (6-14), and 47% (136/291) were classified as severe TBI, 13% (37/291) as moderate TBI, and 40% (114/291) as mild TBI. The median (IQR) injury severity score (ISS) was 24 (16-30). Nearly 48% (141/291) of patients presented at least one infection during hospitalization, and from those, 77% (109/141) were classified as LRTIs, which included tracheitis 55% (61/109), ventilator-associated pneumonia (VAP) 34% (37/109), and hospital-acquired pneumoniae (HAP) 19% (21/109). After multivariable analysis, the following variables were significantly associated with LRTIs: age (OR 1.1, 95% CI 1.01-1.2), severe TBI (OR 2.7, 95% CI 1.1-6.9), AIS thorax (OR 1.4, 95 CI 1.1-1.8), and mechanical ventilation on admission (OR 3.7, 95% CI 1.1-13.5). At the same time, hospital mortality did not differ between groups (LRTI 18.6% vs. No LRTI 20.1%, p = 0.7), and ICU and hospital length of stay (LOS) were longer in the LRTI group (median [IQR] 12 [9-17] vs. 5 [3-9], p < 0.01) and (median [IQR] 21 [13-33] vs. 10 [5-18], p = 0.01), respectively. Time on the ventilator was longer for those with LRTIs. Conclusion The most common site/location of infection in patients with TBI admitted to ICU is respiratory. Age, severe TBI, thoracic trauma, and mechanical ventilation were identified as potential risk factors. LRTI was associated with prolonged ICU, hospital stay, and more days on a ventilator, but not with mortality.
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Affiliation(s)
- Eder Caceres
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
- Neurocritical Care Division, Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia
| | - Juan C. Olivella
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Miguel Yanez
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Emilio Viñan
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Laura Estupiñan
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Natalia Boada
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Ignacio Martin-Loeches
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, St. James's University Hospital, Dublin, Ireland
- Critical Care Department, Trinity Centre for Health Sciences, Dublin, Ireland
- Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Luis Felipe Reyes
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
- Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
- Pandemic Science Institute, University of Oxford, Oxford, United Kingdom
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Predicting tracheostomy in multiple injured patients with severe thoracic injury (AIS ≥ 3) with the new T 3P-Score: a multivariable regression prediction analysis. Sci Rep 2023; 13:3260. [PMID: 36828922 PMCID: PMC9958106 DOI: 10.1038/s41598-023-30461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
Multiple trauma patients with severe chest trauma are at increased risk for tracheostomy. While the risk factors associated with the need for tracheostomy are well established in the general critical care population, they have not yet been validated in a cohort of patients suffering severe thoracic trauma. This retrospective cohort study analysed data on patients aged 18 years or older who were admitted to one of the six participating academic level I trauma centres with multiple injuries, including severe thoracic trauma (AISThorax ≥ 3) between 2010 and 2014. A multivariable binary regression was used to identify predictor variables for tracheostomy and to develop the Tracheostomy in Thoracic Trauma Prediction Score (T3P-Score). The study included 1019 adult thoracic trauma patients, of whom 165 underwent tracheostomy during their intensive care unit (ICU) stay. Prehospital endotracheal intubation (adjusted OR [AOR]: 2.494, 95% CI [1.412; 4.405]), diagnosis of pneumonia during the ICU stay (AOR: 4.374, 95% CI [2.503; 7.642]), duration of mechanical ventilation (AOR: 1.008/hours of intubation, 95% CI [1.006; 1.009]), and an AISHead ≥ 3 (AOR 1.840, 95% CI [1.039; 3.261]) were independent risk factors for tracheostomy. Patients with sepsis had a lower risk of tracheostomy than patients without sepsis (AOR 0.486, 95% CI [0.253; 0.935]). The T3P-Score had high predictive validity for tracheostomy (ROCAUC = 0.938, 95% CI [0.920, 0.956]; Nagelkerke's R2 was 0.601). The T3P-Score's specificity was 0.68, and the sensitivity was 0.96. The severity of thoracic trauma did not predict the need for tracheostomy. Follow-up studies should validate the T3P-Score in external data sets and study the reasons for the reluctant use of tracheostomy in patients with severe thoracic trauma and subsequent sepsis.Trial registration: The study was applied for and registered a priori with the respective ethics committees.
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Song X, Li H, Chen Q, Zhang T, Huang G, Zou L, Du D. Predicting pneumonia during hospitalization in flail chest patients using machine learning approaches. Front Surg 2023; 9:1060691. [PMID: 36684357 PMCID: PMC9852626 DOI: 10.3389/fsurg.2022.1060691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/14/2022] [Indexed: 01/07/2023] Open
Abstract
Objective Pneumonia is a common pulmonary complication of flail chest, causing high morbidity and mortality rates in affected patients. The existing methods for identifying pneumonia have low accuracy, and their use may delay antimicrobial therapy. However, machine learning can be combined with electronic medical record systems to identify information and assist in quick clinical decision-making. Our study aimed to develop a novel machine-learning model to predict pneumonia risk in flail chest patients. Methods From January 2011 to December 2021, the electronic medical records of 169 adult patients with flail chest at a tertiary teaching hospital in an urban level I Trauma Centre in Chongqing were retrospectively analysed. Then, the patients were randomly divided into training and test sets at a ratio of 7:3. Using the Fisher score, the best subset of variables was chosen. The performance of the seven models was evaluated by computing the area under the receiver operating characteristic curve (AUC). The output of the XGBoost model was shown using the Shapley Additive exPlanation (SHAP) method. Results Of 802 multiple rib fracture patients, 169 flail chest patients were eventually included, and 86 (50.80%) were diagnosed with pneumonia. The XGBoost model performed the best among all seven machine-learning models. The AUC of the XGBoost model was 0.895 (sensitivity: 84.3%; specificity: 80.0%).Pneumonia in flail chest patients was associated with several features: systolic blood pressure, pH value, blood transfusion, and ISS. Conclusion Our study demonstrated that the XGBoost model with 32 variables had high reliability in assessing risk indicators of pneumonia in flail chest patients. The SHAP method can identify vital pneumonia risk factors, making the XGBoost model's output clinically meaningful.
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Affiliation(s)
- Xiaolin Song
- School of Medicine, Chongqing University, Chongqing, China,Department of Traumatology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Hui Li
- Department of Traumatology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Qingsong Chen
- Department of Traumatology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Tao Zhang
- School of Medicine, Chongqing University, Chongqing, China,Department of Traumatology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Guangbin Huang
- Department of Traumatology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Lingyun Zou
- Clinical Data Research Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China,Correspondence: Dingyuan Du Lingyun Zou
| | - Dingyuan Du
- Department of Traumatology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China,Correspondence: Dingyuan Du Lingyun Zou
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Wang R, Feng R, Xia C, Ruan F, Luo P, Guo J. Early detection of gram‑negative bacteria using metagenomic next‑generation sequencing in acute respiratory distress syndrome: A case report. Exp Ther Med 2022; 24:573. [PMID: 35949316 PMCID: PMC9353542 DOI: 10.3892/etm.2022.11510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022] Open
Abstract
Metagenomic next-generation sequencing (mNGS) is an effective method that can be used for the identification of early pathogens in patients with suspected severe pneumonia. However, the potential of mNGS for evaluating the prognosis of acute respiratory distress syndrome (ARDS) in patients with severe pneumonia remains unclear. In the present report, hospital-acquired gram-negative bacteria infections were detected in a case using metagenomic next-generation sequencing (mNGS) in a sample of bronchoalveolar fluid. This was obtained from a 58-year-old male patient with traumatic wet lung after a neurosurgery. According to the results, of which the profiles of the resistance genes were detected by mNGS, drugs designed to control infection were adjusted, namely to polymyxin B (500,000 U/12 h), azithromycin (0.5 g/24 h) and ganciclovir (0.25 g/12 h). Following adjusting treatment for 8 days, the symptoms of lung infection and hypoxemia were markedly improved, resulting in the patient being transferred out of the intensive care unit 15 days after treatment. To conclude, observations from the present report suggest that mNGS is a useful method for the early identification of pathogens in patients with pneumonia caused by ARDS. However, further studies are required to identify the complementary role of mNGS in supporting conventional microbiological methods in routine clinical practice.
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Affiliation(s)
- Rong Wang
- Department of Critical Medicine, Union Jiangbei Hospital, Huazhong University of Science and Technology, Wuhan, Hubei 430100, P.R. China
| | - Rong Feng
- Shanghai Topgen Biomedical Technology Co., Ltd., Shanghai 201318, P.R. China
| | - Chaoran Xia
- Shanghai Topgen Biomedical Technology Co., Ltd., Shanghai 201318, P.R. China
| | - Fangying Ruan
- Shanghai Topgen Biomedical Technology Co., Ltd., Shanghai 201318, P.R. China
| | - Peng Luo
- Shanghai Topgen Biomedical Technology Co., Ltd., Shanghai 201318, P.R. China
| | - Jun Guo
- Department of Critical Medicine, Union Jiangbei Hospital, Huazhong University of Science and Technology, Wuhan, Hubei 430100, P.R. China
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The incidence, clinical characteristics, and outcome of polytrauma patients with the combination of pulmonary contusion, flail chest and upper thoracic spinal injury. Injury 2022; 53:1073-1080. [PMID: 34625240 DOI: 10.1016/j.injury.2021.09.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 05/12/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chest trauma was the third most common cause of death in polytrauma patients, accounting for 25% of all deaths from traumatic injury. Chest trauma involves in injury to the bony thorax, intrathoracic organs and thoracic medulla. This study aimed to investigate the incidence, clinical characteristics, and outcome of polytrauma patients with pulmonary contusion, flail chest and upper thoracic spinal injury. METHODS Patients who met inclusion criteria were divided into groups: Pulmonary contusion group (PC); Pulmonary contusion and flail chest group (PC + FC); Pulmonary contusion and upper thoracic spinal cord injury group (PC + UTSCI); Thoracic trauma triad group (TTT): included patients with flail chest, pulmonary contusion and the upper thoracic spinal cord injury coexisted. Outcomes were determined, including 30-day mortality and 6-month mortality. RESULTS A total 84 patients (2.0%) with TTT out of 4176 polytrauma patients presented to Tongji trauma center. There was no difference in mean ISS among PC + FC group, PC + UTSCI group and TTT group. Patients with TTT had a longer ICU stay (21.4 days vs. 7.5 and 6.2; p<0.01), relatively higher 30-day mortality (40.5% vs. 6.0% and 4.3%; p<0.01), and especially higher 6-month mortality (71.4% vs. 6.5%, 13.0%; p<0.01), compared to patients with PC + FC or with PC + UTSCI. The leading causes of death for patients with TTT were ARDS (44.1%) and pulmonary infection (26.5%) during first 30 days after admission. For those patients who died later than 30 days during the 6 months, the predominant underlying cause of death was MOF (53.8%). CONCLUSIONS Lethal triad of thoracic trauma (LTTT) were described in this study, which consisting of pulmonary contusion,flail chest and the upper thoracic spine cord injury. Like the classic "lethal triad", there was a synergy between the factors when they coexist, resulting in especially high mortality rates. Polytrauma patients with LTTT were presented relatively high 30-day mortality and 6 months mortality. We should pay much more attention to the patients with LTTT for further minimizing complications and mortality.
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11
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Schindler CR, Woschek M, Franz JN, Störmann P, Henrich D, Marzi I. Influence of Antibiotic Management on Microbial Selection and Infectious Complications After Trauma. Front Med (Lausanne) 2021; 8:678382. [PMID: 34568354 PMCID: PMC8461005 DOI: 10.3389/fmed.2021.678382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The inflammatory response and post-traumatic complications like infections play an important role in the pathophysiology of severe injuries. This study examines the microbiological aspects in anti-infective treatment of trauma patients and their inflammatory response in post-traumatic infections complications. Patients and Methods: A retrospective analysis of prospectively collected data in trauma patients (ISS ≥ 16) over a 1-year period (01/2018 to 12/2018) is provided. Patient population was stratified into severely injured patients without post-traumatic infection (inf-PT), and severely injured patients who developed an infection (inf+PT). Results: Of 114 trauma patients, 45 suffered from post-traumatic infection during the first 10 days of hospitalization. Severely injured patients with concomitant traumatic brain injury (PT+TBI) showed the highest rate of post-traumatic infection. Pro-inflammatory reaction was tracked by levels of Interleukin (IL-)6 (day 3: inf+T 190.8 ± 359.4 pg/dL > inf-PT 56.2 ± 57.7 pg/mL (mean ± SD); p = 0.008) and C-Reactive-Protein (CRP, day 3: inf+PT 15.3 mg/dL > inf-PT 6.7 mg/dL, p = 0.001) which were significantly higher in trauma patients who develop an infectious complication and showed a significant positive correlation with the occurrence of infection. The leading entity of infection was pneumonia followed by infections of the urinary tract mainly caused by gram-negative Enterobacteriaceae. 67.5% of all trauma patients received single-shot antibiosis during initial care in trauma bay. The development of secondary colonization was not relevant positively correlated with single-shot antibiosis (r = 0.013, p = 0.895) and prophylactically calculated antibiotic administration (r = 0.066, p = 0.500). Conclusion: Severely injured trauma patients have an increased risk for development of infectious complications, which mainly is pneumonia followed by infection of the urinary tract mainly caused by gram-negative Enterobacteriaceae. Based on the data in this study, the one-time antibiotic and prophylactic calculated use of antibiotics, like Cephalosporins must be critically discussed in terms of their role in the development of post-traumatic infections and microbial selection.
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Affiliation(s)
- Cora Rebecca Schindler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Mathias Woschek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Jan-Niklas Franz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Philipp Störmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Dirk Henrich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
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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. Chest 2021; 161:85-96. [PMID: 34186039 DOI: 10.1016/j.chest.2021.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/19/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
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.
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13
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Foster K, Yon J, Pelzl CE, Salottolo K, Mentzer C, Quan G, McGuire EE, Katubig B, Bar-Or D. Six-year national study of damage control laparotomy and the effect of repeat re-exploration on rate of infectious complications. Trauma Surg Acute Care Open 2021; 6:e000706. [PMID: 34212115 PMCID: PMC8208017 DOI: 10.1136/tsaco-2021-000706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/26/2021] [Indexed: 01/15/2023] Open
Abstract
Background Damage control laparotomy (DCL) is a life-saving procedure in patients with abdominal hemorrhage. After DCL, patients are sometimes left with an open abdomen (OA) so they may undergo multiple exploratory laparotomies (EXLAP), or re-explorations. Patients with OA are at increased risk of infectious complications (ICs). The association between number of re-explorations after DCL and the number of ICs is not clear. We hypothesized that each additional re-exploration increases the risk of developing IC. Methods This 6-year retrospective cohort study included patients aged ≥16 years from the NTDB who had DCL defined as EXLAP within 2 hours of arrival (ICD-9: 54.11, 54.12, 54.19) with at least one re-exploration. The primary outcome was IC (ie, superficial surgical site infection (SSI), organ space SSI, deep SSI, sepsis, pneumonia, or catheter-related bloodstream infection), examined dichotomously (present/absent) and ordinally as the number of ICs. Multivariate Poisson regression was used to assess the association between number of re-explorations and number of ICs. Significance was assigned at p<0.01. Results There were 7431 patients who underwent DCL; 2509 (34%) patients developed at least one IC. The rate of IC was lowest in patients who were closed during the first re-exploration (27%) and significantly increased with each re-exploration to 59% in patients who had five or more re-explorations (Cochran-Armitage trend p<0.001). After adjustment, there was 14% increased risk of an additional IC with each re-exploration (p<0.001). Discussion For patients requiring DCL, each re-exploration of the abdomen is associated with increased rate of ICs. Level of evidence III, retrospective epidemiological study.
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Affiliation(s)
- Krislyn Foster
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
| | - James Yon
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
| | - Casey E Pelzl
- Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
| | - Kristin Salottolo
- Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
| | - Caleb Mentzer
- Department of Surgery, Spartanburg Regional, Spartanburg, South Carolina, USA
| | - Glenda Quan
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
| | - Emmett E McGuire
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
| | - Burt Katubig
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
| | - David Bar-Or
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA.,Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
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In response to: The Sequential Clinical Assessment of Respiratory Function score: A dynamic pulmonary physiologic score that predicts adverse outcomes in critically ill rib fracture patients. J Trauma Acute Care Surg 2021; 89:e152. [PMID: 33108140 DOI: 10.1097/ta.0000000000002857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Usman AA, Subramanian M, Raney C, Weaver J, Smith B, Gutsche J, Vernick W, Martin N, Fernandez-Moure J. Recurrent Use of VV ECMO in Refractory Hypoxemia After Penetrating Lung Injury and Multifocal Pneumonia in a Single Individual's ICU Stay. J Cardiothorac Vasc Anesth 2020; 35:1447-1451. [PMID: 32616423 PMCID: PMC7990562 DOI: 10.1053/j.jvca.2020.05.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Asad Ali Usman
- Department of Anesthesiology and Critical Care, Division of Critical Care and Cardiothoracic Anesthesiology, Penn Lung Rescue, University of Pennsylvania, Philadelphia, PA.
| | - Madhu Subramanian
- Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Catherine Raney
- School of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica Weaver
- Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Brian Smith
- Department of Anesthesiology and Critical Care, Division of Critical Care and Cardiothoracic Anesthesiology, Penn Lung Rescue, University of Pennsylvania, Philadelphia, PA
| | - Jacob Gutsche
- Department of Anesthesiology and Critical Care, Division of Critical Care and Cardiothoracic Anesthesiology, Penn Lung Rescue, University of Pennsylvania, Philadelphia, PA
| | - William Vernick
- Department of Anesthesiology and Critical Care, Division of Critical Care and Cardiothoracic Anesthesiology, Penn Lung Rescue, University of Pennsylvania, Philadelphia, PA
| | - Niels Martin
- Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Joseph Fernandez-Moure
- Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, University of Pennsylvania, Philadelphia, PA
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