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Incidence of post-traumatic pneumonia in poly-traumatized patients: identifying the role of traumatic brain injury and chest trauma

  • Martijn HofmanEmail author
  • Hagen Andruszkow
  • Philipp Kobbe
  • Martijn Poeze
  • Frank Hildebrand
Original Article
  • 37 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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)].

Conclusions

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.

Keywords

TBI Chest injury Poly-trauma Pneumonia Mortality 

Abbreviations

AIS

Abbreviated injury scale

ARDS

Acute respiratory distress syndrome

ATLS®

Advanced Trauma Life Support®

GCS

Glasgow Coma Scale

ICU

Intensive care unit

MODS

Multi-organ dysfunction syndrome

NISS

New injury severity score

OR

Odds ratio

paO2/FiO2

Partial pressure of oxygen/fraction of inspired oxygen

SD

Standard deviation

SIRS

Systemic inflammatory response syndrome

SOFA

Sequential organ failure assessment

SPSS

Statistical package for the social sciences

TBI

Traumatic brain injury

VAP

Ventilator-associated pneumonia

Notes

Author contributions

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.

Ethical approval

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.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedic Trauma and Reconstructive SurgeryUniversity of Aachen Medical CenterAachenGermany
  2. 2.Department of Surgery, Division of Trauma SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands

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