title: Trauma-associated pneumonia: time to redefine ventilator-associated pneumonia in trauma patients.
abstract: BACKGROUND
  The high prevalence of ventilator-associated pneumonia (VAP) in trauma patients has been reported in the literature, but the reasons for this observation remain unclear. We hypothesize that trauma factors play critical roles in VAP etiology.
  
  
  METHODS
  In this retrospective study, 1,044 ventilated trauma patients were identified from December 2010 to December 2013. Patient-level trauma factors were used to predict pneumonia as study endpoint.
  
  
  RESULTS
  Ninety-five of the 1,044 ventilated trauma patients developed pneumonia. Rib fractures, pulmonary contusion, and failed prehospital intubation were significant predictors of pneumonia in a multivariate model.
  
  
  CONCLUSIONS
  It is time to redefine VAP in trauma patients based on the effect of rib fractures, pulmonary contusions, and failed prehospital intubations. The Centers for Disease Control and Prevention definition of VAP needs to be modified to reflect the effect of trauma factors in the etiology of trauma-associated pneumonia.
authors.affiliation: HonorHealth John C. Lincoln Medical Center, Department of Trauma Services, 250 E Dunlap Avenue, Phoenix, AZ, USA. Electronic address: alicia.mangram@jcl.com.
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Mangram
authors.affiliation: Arizona College of Osteopathic Medicine, Department of Surgery and Anesthesia, Midwestern University, Glendale, AZ, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Sohn
authors.affiliation: Arizona College of Osteopathic Medicine, Department of Surgery and Anesthesia, Midwestern University, Glendale, AZ, USA.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Zhou
authors.affiliation: HonorHealth John C. Lincoln Medical Center, Department of Trauma Services, 250 E Dunlap Avenue, Phoenix, AZ, USA.
authors.forename: Alexzandra K
authors.initials: AK
authors.lastname: Hollingworth
authors.affiliation: HonorHealth John C. Lincoln Medical Center, Department of Trauma Services, 250 E Dunlap Avenue, Phoenix, AZ, USA.
authors.forename: Francis R
authors.initials: FR
authors.lastname: Ali-Osman
authors.affiliation: HonorHealth John C. Lincoln Medical Center, Department of Trauma Services, 250 E Dunlap Avenue, Phoenix, AZ, USA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sucher
authors.affiliation: HonorHealth John C. Lincoln Medical Center, Department of Trauma Services, 250 E Dunlap Avenue, Phoenix, AZ, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Moyer
authors.affiliation: HonorHealth John C. Lincoln Medical Center, Department of Trauma Services, 250 E Dunlap Avenue, Phoenix, AZ, USA.
authors.forename: James K
authors.initials: JK
authors.lastname: Dzandu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology*; D012042:Registries; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000150:complications*
keywords: Failed prehospital intubation; Pulmonary contusion; Rib fracture; Trauma-associated pneumonia; Ventilator-associated pneumonia