Epidemiology of sepsis in patients with traumatic injury.
OBJECTIVE
To characterize the epidemiology of sepsis in trauma.


METHODS
Analysis of a prospectively collected administrative database (Pennsylvania trauma registry).


METHODS
All trauma centers in the state of Pennsylvania (n = 28)


METHODS
All patients (n = 30,303) with blunt or penetrating injury admitted to Pennsylvania trauma centers over a 2-yr period (January 1996-December 1997).


METHODS
None.


RESULTS
Incidence of sepsis in trauma, independent predictors of sepsis, and associated mortality were evaluated. Analyses controlled for age, gender, preexisting disease, injury type, Revised Trauma Score, Injury Severity Score, and admission vital signs. Sepsis occurred in 2% of all patients and was associated with a significant increase in mortality (23.1% vs. 7.6%, p < .001) compared with nonseptic patients. Respiratory tract infections were the most common cause of sepsis. Septic trauma patients had increased ICU length of stay (21.8 vs. 4.7 days, p < .001) and hospital length of stay (34.1 vs. 7.0 days, p < .001). Logistic regression identified Injury Severity Score, Revised Trauma Score, lower admission Glasgow Coma Scale score, and preexisting diseases as significant independent predictors of sepsis, whereas female gender was associated with a decreased risk of sepsis. Increasing injury severity measured by Injury Severity Score was associated with increased incidence of sepsis. Moderate (Injury Severity Score 15-29) and severe injury (Injury Severity Score >/=30) had a six-fold and 16-fold, respectively, increased incidence of sepsis compared with mild injury. Multivariate analysis confirmed that the effect of sepsis on mortality was greater in trauma patients with mild injury than those with moderate or severe injury.


CONCLUSIONS
This study reports the incidence of sepsis and its associated mortality and critical care resource utilization in a large, state-wide population-based trauma registry. Increasing injury severity, measured by Injury Severity Score, was a significant independent predictor of sepsis in trauma and was associated with increased intensive care unit resource utilization and mortality. These results suggest that future studies should attempt to delineate interventional strategies to prevent sepsis in trauma patients with moderate and severe injury, given their significantly increased risk.
Osborn
Tiffany Medlin
TM
Emergency Medicine and Surgical Critical Care, University of Virginia Health System, Charlottesville, VA, USA.
Tracy
J Kathleen
JK
Dunne
James R
JR
Pasquale
Michael
M
Napolitano
Lena M
LM
D000328:Adult; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010414:Pennsylvania / Q000453:epidemiology; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000150:complications*; D014950:Wounds, Penetrating / Q000150:complications*