Risk factors of mortality in nosocomial infected traumatic patients in a trauma referral center in south of Iran

Yadollahi, Mahnaz; Kashkooe, Ali; Feyzi, Monireh; Bornapour, Saman

doi:10.1016/j.cjtee.2018.03.002

Cited by 8 publications

(6 citation statements)

References 30 publications

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“…Meanwhile, similar studies reported a mean age around 30 years [30,31]. Moreover, our study asserted that trauma and its consequent mortality mainly occur in men, which was consistent with the results obtained from numerous trauma-related studies, showing the majority of injured and deceased patients to be males [27,[32][33][34]. Another issue to remember is that multiple organ traumas had the highest frequency in our study and most fatality cases had also experienced multiple organ injuries.…”

Section: Discussionsupporting

confidence: 91%

A Comparative Study of Injury Severity Scales as Predictors of Mortality in Trauma Patients: Which Scale Is the Best?

Yadollahi

Kashkooe

Rezaiee

et al. 2020

BEAT

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To compare the injury severity scales as predictors of mortality in trauma patients to search for the best scale. Methods: In a prospective cohort study and systematical random sampling conducted from March to September 2017, trauma patients over the age of 13 years were enrolled. The investigated variables were age, gender, systolic blood pressure, heart rate, respiratory rate, injured body region, Glasgow Coma Scale (GCS), injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS) and the outcome. Results: Totally, 1410 trauma patients were followed up, out of which 68.5% were male. The participants' mean age was 43.5±20.88 years. After adjusting the confounding effects, age over 60 years (OR=7.38, CI [3.91-13.93]), GCS<8 (OR=6.5, ), RTS<7.6 (OR=6.04, CI [2-13.7]), and TRISS<0.9 (OR=3.09, CI [1.39-6.88]) were determined as the most significant predictor variables for in-hospital mortality. The results of Receiver Operating Characteristic (ROC) curve revealed that TRISS had the highest area under the curve in comparison to other tests that were evaluated. Furthermore, TRISS had the highest sensitivity and specificity for scores higher than 96.15. By contrast, the sensitivity and specificity of GCS decreased for scores higher than 5.5. Conclusion:Our results showed that TRISS, RTS, GCS, and ISS were all very effective approaches for evaluating prognosis, mortality and probable complications in trauma patients; thus, these systems of injury evaluation and scoring are recommended to facilitate treatment. TRISS, RTS, and ISS had almost the same sensitivity that was higher than GCS, but GCS had the most specificity. Finally, TRISS was selected as the most efficient scale for predicting mortality.

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Section: Discussionsupporting

confidence: 91%

A Comparative Study of Injury Severity Scales as Predictors of Mortality in Trauma Patients: Which Scale Is the Best?

Yadollahi

Kashkooe

Rezaiee

et al. 2020

BEAT

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“…The current results corroborate prior literature showing that even after excluding early deaths, these ICU complications occur commonly following injury, are associated with high morbidity and mortality, and are resource intensive [10][11][12][13]15,[18][19][20][21][22][23][24][25][26][27] . The current data further examines these complications and shows that MOF is a strong independent risk factor for later mortality, resulting in a 65% increased odds of 30-day mortality after adjusting for important cofounders, while NI was not independently associated with mortality.…”

Section: Discussionsupporting

confidence: 88%

Evaluation of critical care burden following traumatic injury from two randomized controlled trials

Campwala

Guyette

Brown

et al. 2023

Sci Rep

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Trauma resuscitation practices have continued to improve with new advances targeting prehospital interventions. The critical care burden associated with severely injured patients at risk of hemorrhage has been poorly characterized. We aim to describe the individual and additive effects of multiorgan failure (MOF) and nosocomial infection (NI) on delayed mortality and resource utilization. A secondary analysis of harmonized data from two large prehospital randomized controlled trials (Prehospital Air Medical Plasma (PAMPer) Trial and Study of Tranexamic Acid during Air and Ground Medical Prehospital Transport (STAAMP) Trial) was conducted. Only those patients who survived beyond the first 24 hours post-injury and spent at least one day in the ICU were included. Patients were stratified by development of MOF only, NI only, both, or neither and diagnosis of early (≤ 3 days) versus late MOF (> 3 days). Risk factors of NI and MOF, time course of these ICU complications, associated mortality, and hospital resource utilization were evaluated. Of the 869 patients who were enrolled in PAMPer and STAAMP and who met study criteria, 27.4% developed MOF only (n = 238), 10.9% developed NI only (n = 95), and 15.3% were diagnosed with both MOF and NI (n = 133). Patients developing NI and/or MOF compared to those who had an uncomplicated ICU course had greater injury severity, lower GCS, and greater shock indexes. Early MOF occurred in isolation, while late MOF more often followed NI. MOF was associated with 65% higher independent risk of 30-day mortality when adjusting for cofounders (OR 1.65; 95% CI 1.04–2.6; p = 0.03), however NI did not significantly affect odds of mortality. NI was individually associated with longer mechanical ventilation, ICU stay, hospital stay, and rehabilitation requirements, and the addition of MOF further increased the burden of inpatient and post-discharge care. MOF and NI remain common complications for those who survive traumatic injury. MOF is a robust independent predictor of mortality following injury in this cohort, and NI is associated with higher resource utilization. Timing of these ICU complications may reveal differences in pathophysiology and offer targets for continued advancements in treatment.

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“…Our study demonstrated that urinary tract infections were the second most common nosocomial infections, which is in concordance with previously published literature in trauma patients. 16 TBI patients often have associated peripheral injuries, and these open wounds provide additional access routes of infection in these patients. Our study showed that skin and soft-tissue infections were common in these patients and comprised 15% of total infections.…”

Section: Discussionmentioning

confidence: 99%

Nosocomial Infections in Patients with Traumatic Brain Injury: A Hospital-Based Study from North India

Koul

Sheikh

Bhat

et al. 2021

Indian Journal of Neurosurgery

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Background Traumatic brain injury (TBI) is a major global health concern, it being a leading cause of morbidity and mortality in young adults. Infections acquired in the hospital setting are one of many risk factors that are associated with higher mortality in this population. Despite significant impact on the overall outcome, infections in TBI patients are largely understudied and underreported. The purpose of this study was to study the profile of infectious complications in patients with TBI and impact of these infections on the hospital outcome of these patients. Materials and Methods The medical records of all the patients with a diagnosis of TBI admitted in our hospital from January 2017 to January 2020 were reviewed. They were screened for presence of any predefined infection acquired at any time during their hospital stay. Data regarding demographics, focus of infection, results of various cultures, and hospital outcome was recorded. Results A total of 60 patients with TBI who had developed nosocomial infections were included in this observational study. Patients were mostly young, with a mean age of 36.6 years. Majority (66.6%) of patients who developed infectious complications had Glasgow coma scale (GCS) score of less than 10. Respiratory tract and urinary tract were the most common sites of infections in these patients. Burkholderia cepecia and Acinetobacter baumannii were the two most common isolated organisms. All-cause mortality in this population was 23.3%. Conclusions Most TBI patients are young, in their productive period of lives, and do not have major comorbidities. Invariably, they have low GCS scores and encounter a breach of their surface immunity due to catheters, procedures, and intubation. Such patients make an extremely significant impact on hospital resources as well as poor economic outcomes.

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Risk factors of mortality in nosocomial infected traumatic patients in a trauma referral center in south of Iran

Cited by 8 publications

References 30 publications

A Comparative Study of Injury Severity Scales as Predictors of Mortality in Trauma Patients: Which Scale Is the Best?

A Comparative Study of Injury Severity Scales as Predictors of Mortality in Trauma Patients: Which Scale Is the Best?

Evaluation of critical care burden following traumatic injury from two randomized controlled trials

Nosocomial Infections in Patients with Traumatic Brain Injury: A Hospital-Based Study from North India

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