title: Emergency department length of stay: a major risk factor for pneumonia in intubated blunt trauma patients.
abstract: BACKGROUND
  Pneumonia occurs commonly in intubated patients and is morbid and occasionally mortal. Pneumonia prevention strategies have been successful in the intensive care unit and are favorably regarded, cost effective, and efficacious. Trauma patients are often intubated emergently in the prehospital or emergency department (ED) setting. Nationwide, hospital crowding has resulted in prolonged ED length of stay (LOS). We sought to study the association between prolonged ED LOS and rates of pneumonia.
  
  
  METHODS
  This was a 2-year retrospective case-control study of pneumonia risk among blunt trauma patients presenting to an urban Level I trauma center who were emergently intubated. The trauma registry was queried for demographic and clinical information. All patients who were intubated prehospital or in the ED and developed pneumonia were identified as cases. A group of matched controls with equivalent age, injury severity score, abbreviated injury score (AIS) chest, and AIS head who did not develop pneumonia were identified. A comparison of ED LOS between the two groups was assessed using conditional logistic regression.
  
  
  RESULTS
  We identified 509 emergently intubated blunt trauma patients. Of these, 33 developed pneumonia and could be matched with comparable controls. The case subjects had a mean age of 44.6 (+/-24.3), a mean injury severity score of 32.7 (+/- 9.4), a mean chest AIS of 1.5 (+/-1.6), and a mean head AIS of 4.4 (+/-1.2). The ED LOS for the cases was significantly longer than that for the controls (281.3 minutes vs. 214.0 minutes, p < 0.05). Each hour increased the risk of developing pneumonia by approximately 20%.
  
  
  CONCLUSIONS
  In blunt trauma patients who are emergently intubated, increased ED LOS is an independent risk factor for pneumonia. Ventilator associated pneumonia interventions, successful in the intensive care unit, should be implemented early in the hospital course, and efforts should be made to minimize hospital crowding and ED LOS.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA. Brendan.Carr@uphs.upenn.edu
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Kaye
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Wiebe
authors.forename: Vicente H
authors.initials: VH
authors.lastname: Gracias
authors.forename: C William
authors.initials: CW
authors.lastname: Schwab
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Reilly
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000628:therapy