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Identification of early predictors for post-traumatic pneumonia
M A Croce1, T C Fabian, L Waddle-Smith
1Department of Surgery, Presley Regional Trauma Center, University of Tennessee, Memphis 38163, USA.
The American Surgeon
|March 13, 2001
Summary
Standard clinical signs are unreliable for diagnosing post-traumatic pneumonia. Quantitative bronchoalveolar lavage cultures identify pneumonia, and early risk factor identification aids targeted research and interventions.
Area of Science:
- Trauma Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Standard clinical criteria for post-traumatic pneumonia (fever, leukocytosis, purulent sputum, chest radiograph infiltrate) are nonspecific.
- Approximately 50% of patients meeting these criteria actually have pneumonia, necessitating a more precise diagnostic method.
Purpose of the Study:
- To identify independent predictors of post-traumatic pneumonia using quantitative bronchoalveolar lavage cultures.
- To enable early identification of high-risk patients for targeted research and management.
Main Methods:
- Retrospective review of 7503 trauma patients surviving > 48 hours over 22 months.
- Pneumonia defined as >= 10^5 organisms/mL in bronchoalveolar lavage effluent.
- Logistic regression analysis to identify risk factors, including injury severity and shock parameters.
Main Results:
- The incidence of pneumonia was 6% overall (7% blunt, 2% penetrating trauma).
- Independent predictors of pneumonia included age, Glasgow Coma Scale score, Injury Severity Score, transfusion needs, spinal cord injury, chest injury severity, and emergent surgeries (femur fixation, craniotomy, laparotomy).
Conclusions:
- Multiple early-determinable risk factors predict post-traumatic pneumonia.
- Prompt identification of high-risk patients allows for better prognostic considerations and targeted prophylactic measures or immunomodulation.