Incidence of post-traumatic pneumonia in poly-traumatized patients: identifying the role of traumatic brain injury and chest trauma
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Traumatic brain injury (TBI) and chest trauma are common injuries in severely injured patients. Both entities are well known to be associated with severe post-traumatic complications, including pneumonia, a common complication with a significant impact on the further clinical course. However, the relevance of TBI, chest trauma and particularly their combination as risk factors for the development of pneumonia and its impact on outcomes are not fully elucidated.
A retrospective analysis of poly-traumatized patients treated between 2010 and 2015 at a level I trauma centre was performed. Inclusion criteria were: Injury Severity Score ≥ 16 and age ≥ 18 years. TBI and chest trauma were classified according to the Abbreviated Injury Scale. Complications (i.e. acute respiratory distress syndrome (ARDS), multi-organ dysfunction syndrome (MODS) and pneumonia) were documented by a review of the medical records. The primary outcome parameter was in-hospital mortality.
Over the clinical course, 19.9% of all patients developed pneumonia, and in-hospital mortality was 25.3%. Pneumonia (OR 5.142, p = 0.001) represented the strongest independent predictor of in-hospital mortality, followed by the combination of chest injury and TBI (OR 3.784, p = 0.008) and TBI (OR 3.028, p = 0.010). Chest injury alone, the combination of chest injury and TBI, and duration of ventilation were independent predictors of pneumonia [resp. OR 4.711 (p = 0.004), OR 4.193 (p = 0.004), OR 1.002 (p < 0.001)].
Chest trauma alone and especially its combination with TBI represent high-risk injury patterns for the development of pneumonia, which forms the strongest predictor of mortality in poly-traumatized patients.
KeywordsTBI Chest injury Poly-trauma Pneumonia Mortality
Abbreviated injury scale
Acute respiratory distress syndrome
Advanced Trauma Life Support®
Glasgow Coma Scale
Intensive care unit
Multi-organ dysfunction syndrome
New injury severity score
Partial pressure of oxygen/fraction of inspired oxygen
Systemic inflammatory response syndrome
Sequential organ failure assessment
Statistical package for the social sciences
Traumatic brain injury
MH designed the study, obtained the data and wrote the manuscript; HA performed the statistical analysis of the data; PK designed the study; and FH and MP reviewed the manuscript. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
All data in this study were obtained in accordance with the ethical standards of both institutional and/or national research committees and with the guidelines of the revised United Nations declaration of Helsinki in 1975 and its latest revision in 2013 (seventh revision) or comparable ethical standards.
- 3.Kristiansen T, Lossius HM, Rehn M, Kristensen P, Gravseth HM, Roislien J, et al. Epidemiology of trauma: a population-based study of geographical risk factors for injury deaths in the working-age population of Norway. Injury. 2014;45(1):23–30. https://doi.org/10.1016/j.injury.2013.07.007.CrossRefGoogle Scholar
- 5.Jovanovic B, Milan Z, Djuric O, Markovic-Denic L, Karamarkovic A, Gregoric P, et al. Twenty-eight-day mortality of blunt traumatic brain injury and co-injuries requiring mechanical ventilation. Med Princ Pract Int J Kuwait Univ Health Sci Cent. 2016;25(5):435–41. https://doi.org/10.1159/000447566.Google Scholar
- 12.Calhoon JH, Trinkle JK. Pathophysiology of chest trauma. Chest Surg Clin N Am. 1997;7(2):199–21111.Google Scholar
- 18.Jones AE, Trzeciak S, Kline JA. The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med. 2009;37(5):1649–54. https://doi.org/10.1097/CCM.0b013e31819def97.CrossRefGoogle Scholar
- 19.Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10.CrossRefGoogle Scholar
- 29.Haenel JB, Moore FA, Moore EE. Pulmonary consequences of severe chest trauma. Respir Care Clin N Am. 1996;2(3):401–24.Google Scholar
- 33.Walaszek M, Kosiarska A, Gniadek A, Kolpa M, Wolak Z, Dobros W, et al. The risk factors for hospital-acquired pneumonia in the intensive care unit. Prz Epidemiol. 2016;70(1):15–20 (107–110).Google Scholar
- 39.Yucel N, Ozturk Demir T, Derya S, Oguzturk H, Bicakcioglu M, Yetkin F. Potential risk factors for in-hospital mortality in patients with moderate-to-severe blunt multiple trauma who survive initial resuscitation. Emerg Med Int. 2018;2018:6461072. https://doi.org/10.1155/2018/6461072.CrossRefGoogle Scholar
- 42.Kesinger MR, Kumar RG, Wagner AK, Puyana JC, Peitzman AP, Billiar TR, et al. Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge. J Trauma Acute Care Surg. 2015;78(2):396–402. https://doi.org/10.1097/TA.0000000000000526.CrossRefGoogle Scholar