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Pneumonia After Trauma Risk Factors

Purpose: To identify risk factors for pneumonia in a trauma patient using the risk factors of Antonelli et al.

Description

Antonelli et al identified risk factors in trauma patients associated with early and late onset pneumonia. This can help identify patients who may benefit from closer monitoring and more aggressive management. The authors are from Rianimazione Universita "La Sapienza" in Rome.


 

Onset of Pneumonia

Descriptor

onset within first 4 days (96 hours)

early onset

onset after the first 96 hours

late onset

 

Risk factors for early onset pneumonia (from logistic regression analysis):

(1) combined severe thoracic and abdominal trauma (thorax AIS > 4, abdomen AIS > 9)

(2) age > 40 years

(3) mechanical ventilation < 24 hours during the first 4 days of hospitalization

 

where:

• I am not sure how one gets an AIS of 9 for the abdomen. The maximum regional score would be a 6, which is a fatal lesion. A moderate injury is graded 2 and a severe injury is graded 3.

• One option is that they are referring to the square of the regional value. The injury severity score combines the square of the highest regional injuries.

• A second option is that they are combining multiple abdominal injuries.

• The only thing that makes sense is that they are referring to the squared value for the regional injury. "Thorax AIS > 4" would refer to regional injuries graded 3, 4 or 5. "Abdominal AIS > 9" would refer to regional injuries graded 4 or 5.

 

Risk factors for late onset pneumonia (from logistic regression analysis):

(1) abdominal AIS > 4

(2) mechanical ventilation for > 5 days

 

where:

• The abstract refers to an AIS > 4, but the text on page 226 says >=4. If they are using the square of the regional injury grade then "> 4" would refer to a regional injury of 3 to 5.


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Specialty

Objective

ICD-10