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Infections in severely traumatized children
L M Bell1, M D Baker, D Beatty
1Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, PA 19104.
Insights
Infections are common in severely injured children, with most being hospital-acquired. Preventing these infections can significantly shorten hospital stays for pediatric trauma patients.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
Background:
- Severely traumatized children are at risk for infections during hospitalization.
- Understanding infection types and risk factors is crucial for improving outcomes.
Purpose of the Study:
- To determine the incidence and types of infections in severely traumatized children.
- To identify risk factors associated with nosocomial infections.
- To assess the impact of nosocomial infections on hospitalization length.
Main Methods:
- Retrospective review of medical charts for 212 hospitalized children with severe trauma who received antibiotics.
- Analysis of infection types (trauma-related vs. nosocomial) and timing.
- Statistical analysis to identify risk factors and impact on length of stay.
Main Results:
- Overall infection incidence was 19%, with 71% being nosocomial infections.
- Common nosocomial infections included tracheitis, sepsis, and urinary tract infections, typically diagnosed in the second week post-injury.
- Severe head injury was a significant risk factor for nosocomial infections (OR 6.8).
- Nosocomial infections prolonged hospitalization by an average of 16 days.
Conclusions:
- Nosocomial infections are prevalent in severely traumatized children and are associated with prolonged hospital stays.
- Identifying and mitigating risk factors, such as severe head injury, is essential for infection prevention.
- Preventing nosocomial infections can significantly reduce hospitalization duration in pediatric trauma patients.
Abstract:
To study the incidence and types of infection among severely traumatized children, we reviewed the medical charts of 212 children, hospitalized following traumatic injury, who received antibiotics at sometime during their hospitalization. Infection occurred in 19%. Eleven children had trauma-related infections, whereas 29 (71% of those infected) had 36 nosocomial infections. Tracheitis, sepsis, and urinary tract infections were the most common nosocomial infections and were diagnosed in the second week (10 +/- 3 days) following injury. Nosocomial infections were more likely to develop in children who were more severely injured and who had a greater number of invasive procedures. Severe head injury (cerebral edema or subarachnoid hemorrhage) was more common in those with nosocomial infection (P < .0002, odds ratio 6.8, 95% confidence interval 2.2 to 21.3). Those without these injuries were much less likely to develop nosocomial infections (specificity 97% and negative predictive value 86%). Finally, the development of any nosocomial infection prolonged the hospitalization by a mean of 16 +/- 6 days when comparing children with the same degree of traumatic injury. Prevention of nosocomial infection in children with severe trauma will significantly reduce length of hospitalization.