title: Impact of smoking on trauma patients.
abstract: BACKGROUND
  The harmful effects of smoking have been well-documented in the medical literature for decades. To further the support of smoking cessation, we investigate the effect of smoking on a less studied population, the trauma patient.
  
  
  METHODS
  All trauma patients admitted to the surgical intensive care unit at the LAC + University of Southern California medical center between January 2007 and December 2011 were included. Patients were stratified into two groups - current smokers and non-smokers. Demographics, admission vitals, comorbidities, operative interventions, injury severity indices, and acute physiology and chronic health evaluation (APACHE) II scores were documented. Uni- and multi-variate modeling was performed. Outcomes studied were mortality, duration of mechanical ventilation, and length of hospitalization.
  
  
  RESULTS
  A total of 1754 patients were available for analysis, 118 (6.7%) patients were current smokers. The mean age was 41.4±20.4, 81.0% male and 73.5% suffered blunt trauma. Smokers had a higher incidence of congestive heart failure (4.2% vs. 0.9%, p=0.007) and alcoholism (20.3% vs. 5.9%, p<0.001), but had a significantly lower APACHE II score. After multivariate regression analysis, there was no significant mortality difference. Patients who smoked spent more days mechanically ventilated (beta coefficient: 4.96 [1.37, 8.55, p=0.007]).
  
  
  CONCLUSIONS
  Smoking is associated with worse outcome in the critically ill trauma patient. On an average, smokers spent 5 days longer requiring mechanical ventilation than non-smokers.
authors.affiliation: LAC+USC Medical Center, Los Angeles, California, United States of America. shelby.resnick@med.usc.edu.
authors.forename: Shelby
authors.initials: S
authors.lastname: Resnick
authors.affiliation: LAC+USC Medical Center, Los Angeles, California, United States of America.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.affiliation: LAC+USC Medical Center, Los Angeles, California, United States of America.
authors.forename: Obi
authors.initials: O
authors.lastname: Okoye
authors.affiliation: LAC+USC Medical Center, Los Angeles, California, United States of America.
authors.forename: Lauren
authors.initials: L
authors.lastname: Nosanov
authors.affiliation: LAC+USC Medical Center, Los Angeles, California, United States of America.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grabo
authors.affiliation: LAC+USC Medical Center, Los Angeles, California, United States of America.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Benjamin
authors.affiliation: LAC+USC Medical Center, Los Angeles, California, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Smith
authors.affiliation: LAC+USC Medical Center, Los Angeles, California, United States of America.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D018806:APACHE; D000328:Adult; D002140:California / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology*; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult