title: Witnessed aspiration in trauma: Frequent occurrence, rare morbidity--A prospective analysis.
abstract: BACKGROUND
  Aspiration events (AEs) are a well-recognized complication in trauma patients and have traditionally been considered a risk factor for pneumonia. Despite this, there is no consensus on the incidence or clinical significance of AE in the trauma population.
  
  
  METHODS
  All patients admitted as trauma team activations at our Level I trauma center who were intubated in the field or on arrival from September 2013 to August 2014 were prospectively collected. Field and admission data including witnessed AEs were analyzed. Additional hospital data included imaging, associated injuries, laboratory, and clinical data. Early respiratory failure, pneumonia, and hospital mortality were collected.
  
  
  RESULTS
  During the study period, 228 patients met inclusion criteria. Median age was 35.5 years, and Injury Severity Score (ISS) was 21.0. Overall, 58 patients (25.4%) had witnessed AEs. Patients with AE had significantly higher ISS (26.0 vs. 17.0, p = 0.027) and lower Glasgow Coma Scale (GCS) score on admission (median, 4.0 vs. 7.0; p = 0.003), despite similar field GCS score (p = 0.946). Body mass index (median, 27.2 vs. 26.2; p = 0.374) and intoxication rates (86.2% vs. 83.5%, p = 0.835) were similar between groups. Early pneumonia and respiratory failure were rare in all patients and were not higher in those with AE. Although mortality was higher after AE in patients who died directly after admission (51.7% vs. 30.0%, p = 0.004), in patients who survived to intensive care unit admission, there was no longer a difference between groups and aspiration was not an independent predictor of mortality (p = 0.107) on multivariable regression analysis.
  
  
  CONCLUSIONS
  The rate of aspiration in trauma is high and more likely to occur in patients with increased injury burden or depressed GCS score. In patients who survive past admission, early pneumonia rates are similar, regardless of AE. These data suggest that aspiration is a marker of severe illness and is associated with but not an independent predictor of mortality.
  
  
  METHODS
  Prognostic/epidemiologic study, level III.
authors: From the Division of Trauma and Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California.
authors: Elizabeth
authors: E
authors: Benjamin
authors: Tobias
authors: T
authors: Haltmeier
authors: Konstantinos
authors: K
authors: Chouliaras
authors: Stefano
authors: S
authors: Siboni
authors: Joseph
authors: J
authors: Durso
authors: Kenji
authors: K
authors: Inaba
authors: Demetrios
authors: D
authors: Demetriades
mesh_terms: D000328:Adult; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D053120:Respiratory Aspiration / Q000209:etiology*; D012307:Risk Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications*