Late outcomes of trauma patients with infections during index hospitalization.
BACKGROUND
Injured patients have significant risk of infection during initial hospitalization. We hypothesized that infected trauma patients would have worse late outcomes.


METHODS
From 69 centers, patients with moderate-severe injuries and at least one selected infection during hospitalization were compared with those without an infection. Outcomes measured at 3 months and 12 months postinjury included death, subscales on the Medical Outcomes Short Form Health Survey (SF-36), Revised Center for Epidemiologic Studies Depression Scale, the cognitive subscale of the Functional Capacity Index, the Mobility and Fine Motor subscales of the Musculoskeletal Function Assessment, return to work, and healthcare utilization postdischarge.


RESULTS
Of 4,732 patients, 668 had >or=1 infection. Patients with hospitalizations complicated by infection had a higher risk of death within 1 year after injury, hazard ratio 1.56 (95%confidence interval [CI] 1.13-2.15). Surviving patients with infections had lower SF-36 physical function scores and patients older than 65 years also demonstrated lower scores in general health, vitality, emotional and social function. Postdischarge, infected patients were more likely to have repeat hospitalizations, need home health services (relative risk [RR] 1.19, 95% CI 1.03-1.37 and RR 1.68, 95% CI 1.12-2.52, respectively) and require 3 more hours of care from family/friends per month. They were also less likely to have returned to work (odds ratio 1.67, 95% CI 1.20-2.32). However, infected patients were at less risk of being depressed 12 months postinjury (RR 0.77, 95% CI 0.62-0.97).


CONCLUSIONS
Trauma patients with an infection during hospitalization demonstrate worsened functional status and increased healthcare usage up to a year after injury compared with those without an infection. Future interventions need to target decreasing infection risk as well as close follow-up after discharge.
Czaja
Angela S
AS
Critical Care Division, Department of Pediatrics, University of Colorado, Aurora, Colorado 80045, USA. czaja.angela@tchden.org
Rivara
Frederick P
FP
Wang
Jin
J
Koepsell
Thomas
T
Nathens
Avery B
AB
Jurkovich
Gregory J
GJ
Mackenzie
Ellen
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality; D055815:Young Adult