Polymorphonuclear leukocyte migration abnormalities and their significance in seriously traumatized patients

Polymorphonuclear leukocyte (PMN) locomotory responses were studied in 24 patients who sustained serious blunt trauma, mostly from motor vehicle accidents. The results showed the presence of a combined cell- and serum-associated locomotory abnormality. The serum abnormality was due to a cell-directed inhibitor, and was present for an average of 3 days. The cell-associated abnormality persisted for approximately 1 week in uninfected patients, and 2 weeks in the infected group. Both mature and immature forms of PMNs contribute to the PMN locomotory dysfunction observed. A significant correlation was observed between the degree of PMN locomotory abnormality or injury severity score and the infection rate. Eighteen infections (six suspected and 12 definite) were observed in 11 of the 24 patients. Twelve (67%) infections involved the lungs. Nine patients (82%) showed evidence of infection by day 6. PMN dysfunction in trauma is associated with increased infection rate and is not due solely to increased numbers of immature forms of PMNs.