title: The Severity of Injury and the Extent of Hemorrhagic Shock Predict the Incidence of Infectious Complications in Trauma Patients.
abstract: BACKGROUND
  Trauma patients are at high risk of developing systemic inflammatory response syndrome (SIRS) and infections. The aim of this study was to evaluate the influence of the severity of injury and the extent of hemorrhagic shock at admission on the incidence of SIRS, infection and septic complications.
  
  
  METHODS
  A total of 972 patients who had an injury severity score (ISS) of ≥ 17, survived more than 72 h, and were admitted to a level I trauma center within 24 h after trauma were included in this retrospective analysis. SIRS, sepsis and infection rates were measured in patientswith different severities of injury as assessed by ISS, or with various degrees of hemorrhagic shock according to ATLS(®) guidelines, andwere compared using both uni- and multivariate analysis.
  
  
  RESULTS
  Infection rates and septic complications increase significantly (p < 0.001) with higher ISS. Severe hemorrhagic shock on admission is associated with a higher rate of infection (72.8%) and septic complications (43.2%) compared to mild hemorrhagic shock (43.4%, p < 0.001 and 21.7%, p < 0.001, respectively).
  
  
  CONCLUSIONS
  The severity of injury and the severity of hemorrhagic shock are risk factors for infectious and septic complications. Early diagnostic and adequate therapeutic work up with planned early "second look" interventions in such high-risk patients may help to reduce these common posttraumatic complications.
authors.affiliation: Department of Trauma Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lustenberger
authors.affiliation: Department of Trauma Surgery, University Hospital of Zurich, Zurich, Switzerland. mturina73@hotmail.com.|Department of Trauma Surgery, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. mturina73@hotmail.com.
authors.forename: Matthias
authors.initials: M
authors.lastname: Turina
authors.affiliation: Biostatistics Unit, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Department of Trauma Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Ladislav
authors.initials: L
authors.lastname: Mica
authors.affiliation: Department of Trauma Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Marius
authors.initials: M
authors.lastname: Keel
keywords: Hemorrhagic shock; Infection; Injury severity score; Systemic inflammatory response syndrome; Trauma
references.citation: J Trauma. 2002 Aug;53(2):245-50; discussion 250-1
references.pmid: 12169929
references.citation: Nature. 2005 Oct 13;437(7061):1032-7
references.pmid: 16136080
references.citation: Transpl Immunol. 2002 Aug;10(2-3):183-90
references.pmid: 12216948
references.citation: J Trauma. 1987 Jul;27(7):774-81
references.pmid: 3612852
references.citation: Am J Infect Control. 1988 Jun;16(3):128-40
references.pmid: 2841893
references.citation: Am Surg. 2001 Feb;67(2):105-10
references.pmid: 11243529
references.citation: J Trauma. 2003 May;54(5):898-905; discussion 905-7
references.pmid: 12777902
references.citation: Blood Rev. 2001 Jun;15(2):69-83
references.pmid: 11409907
references.citation: J Neurosurg. 1978 May;48(5):673-8
references.pmid: 641547
references.citation: Am J Infect Control. 1999 Apr;27(2):79-83
references.pmid: 10196483
references.citation: World J Surg. 1996 May;20(4):392-400
references.pmid: 8662125
references.citation: Am J Respir Crit Care Med. 2007 Apr 15;175(8):763-7
references.pmid: 17255558
references.citation: J Trauma. 1988 Jan;28(1):69-77
references.pmid: 3123707
references.citation: Ann Surg. 1999 May;229(5):651-60; discussion 660-1
references.pmid: 10235523
references.citation: Am J Surg. 1993 Sep;166(3):244-7
references.pmid: 8368434
references.citation: Acta Anaesthesiol Scand. 2001 Jul;45(6):710-9
references.pmid: 11421829
references.citation: J Trauma. 1991 Aug;31(8):1083-6; discussion 1086-7
references.pmid: 1875434
references.citation: Unfallchirurg. 1998 Jul;101(7):520-6
references.pmid: 9739215
references.citation: JAMA. 2003 Apr 16;289(15):1941-9
references.pmid: 12697796
references.citation: Am J Respir Crit Care Med. 1996 Jan;153(1):343-9
references.pmid: 8542141
references.citation: Crit Care Med. 2000 Aug;28(8):3090-1
references.pmid: 10966307
references.citation: J Trauma. 2001 May;50(5):817-20
references.pmid: 11379594
references.citation: J Trauma. 2003 Apr;54(4):724-9; discussion 729-30
references.pmid: 12707535
references.citation: J Trauma. 2000 May;48(5):932-7
references.pmid: 10823539
references.citation: J Trauma. 1999 Nov;47(5):923-7
references.pmid: 10568723
references.citation: J Trauma. 1998 Sep;45(3):545-9
references.pmid: 9751548
references.citation: Arch Surg. 1991 Jan;126(1):97-9
references.pmid: 1985639
references.citation: Injury. 2006 May;37(5):455-65
references.pmid: 16476429
references.citation: Transfus Med Rev. 2002 Oct;16(4):304-14
references.pmid: 12415516
references.citation: J Trauma. 2000 Oct;49(4):647-52; discussion 652-3
references.pmid: 11038081
references.citation: JAMA. 1980 Mar 21;243(11):1156-9
references.pmid: 7359667
references.citation: J Trauma. 1992 Nov;33(5):659-61
references.pmid: 1464912
references.citation: Injury. 2003 Jun;34(6):397-404
references.pmid: 12767787
references.citation: Injury. 2007 Dec;38(12):1405-8
references.pmid: 18048035