Urgent airways after trauma: who gets pneumonia?
BACKGROUND
Several risk factors, including emergent intubation, severe head injury, shock, blunt trauma, and high severity of injury, have been identified as risk factors for the development of pneumonia after trauma. This study assesses the contribution of emergent intubation to the development of pneumonia after injury.


METHODS
A retrospective review of all trauma patients requiring intubation or cricothyroidotomy in the Emergency Department (ED) or in the pre-hospital area (field) over a 41/2 year period.


RESULTS
571 patients comprised the study population. Of these, 80% had airways established in the ED, while 20% were intubated in the field. Field intubation was associated with a lower Glasgow Coma Scale (GCS) score (p <0.0001) and more severe injury (p <0.0001), particularly to the chest and extremities.Twenty-five percent of the population developed pneumonia. Patients diagnosed with pneumonia were older (p=0.009), and had a higher ISS (p <0.0001), lower GCS score, (p <0.008), longer ICU and hospital length of stay (p < 0.0001). Injuries to the head, thorax and extremities were more common (p < 0.05) and more severe (p <0.05) in patients developing pneumonia. The incidence of pneumonia after field airway was significantly higher (35% versus 23%, p=0.048).Multiple logistic regression analysis identified field intubation, age, AIS-head, and AIS-extremity as independent risk factors for pneumonia.


CONCLUSIONS
Pre-hospital but not ED intubation is an independent risk factor for the development of post-traumatic pneumonia. Other predictors include the severity of injury, specifically head and extremity injuries.
Eckert
Matthew J
MJ
Department of Surgery, Division of Trauma, Surgical Critical Care and Burns, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Davis
Kimberly A
KA
Reed
R Lawrence
RL
Santaniello
John M
JM
Poulakidas
Stathis
S
Esposito
Thomas J
TJ
Luchette
Fred A
FA
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000209:etiology*; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*