Early onset pneumonia in severe chest trauma: a risk factor analysis.
BACKGROUND
The development of an early-onset pneumonia (EOP), occurring within the first 72 hours after admission, represents a critical event in severe thoracic trauma population. The aim of this study was to determine risk factors associated with the occurrence of this complication in this specific population.


METHODS
A retrospective review of a prospective implemented trauma registry was conducted during a 4-year period in a Level I trauma center. Over the study period, 223 severely injured patients were admitted with severe thoracic trauma (Injury Severity Score >16 and Thorax Abbreviated Injury Score >2). Multiple logistic regression analysis was used to determine the independent predictors of EOP based on the clinical characteristics and the initial management both in the field and after admission in the trauma center.


RESULTS
Independent predictors of EOP were the necessity of intubation and mechanical ventilation in the field (adjusted odds ratio [OR]: 11.8; 95% confidence interval [CI]: 4.3-32.7), a history of aspiration (OR: 28.6; 95% CI: 4.0-203.5), the presence of pulmonary contusion (OR: 7.0; 95% CI: 2.0-23.9), and the occurrence of a hemothorax (OR: 3.2; 95% CI: 1.4-7.6).


CONCLUSIONS
These results emphasize the influence of prehospital and early factors in the further occurrence of EOP, which allows the development of early and specific clinical management to prevent it.
Réanimation des Urgences, Hôpital Sainte Marguerite, Université de la Méditerranée, Marseille, France. pierre.michelet@ap-hm.fr
Pierre
P
Michelet
David
D
Couret
Fabienne
F
Brégeon
Gilles
G
Perrin
Xavier-Benoit
XB
D'Journo
Véronique
V
Pequignot
Véronique
V
Vig
Jean-Pierre
JP
Auffray
D000328:Adult; D004322:Drainage; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology* / Q000517:prevention & control; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013898:Thoracic Injuries / Q000150:complications*; D013997:Time Factors; D055815:Young Adult