COMPLICATIONS OF TRAUMA CARE - RISK ANALYSIS OF PNEUMONIA IN 10,001 ADULT TRAUMA PATIENTS

Five year's experience recorded in the adult registry of a Level I tra uma center was reviewed to identify all recorded complications. Patien ts in whom pneumonia occurred were further analyzed for associated ris k factors and for potentially preventable occurrence. Of 10,001 patien ts, 1027 (10%) sustained a total of 1905 complications. Patients with complications were more severely injured (mean Injury Severity Score = 27.5 versus 9.6; P < 0.01). Pneumonia occurred in 392 patients and wa s the most frequently encountered complication. Mortality for patients with uncomplicated care was 5.8 per cent in comparison with 46 per ce nt for those with any complications (P < 0.001), and 30.3 per cent for the pneumonia group (P < 0.05). Age >65 years, Injury Severity Score >15, Glasgow coma scale score <8, cervical spine fracture with spinal cord injury, Abbreviated Injury Scale >3 for head, chest, and abdomen regions were associated with an increased risk of pneumonia (P < 0.001 ). Forty-four patients who developed pneumonia (11%) presented without any risk factor. Two of five related deaths could be considered poten tially preventable. We conclude that the incidence of complications re lated to trauma care increases with injury severity and that complicat ions are associated with a significantly higher mortality. The frequen cy of pneumonia, 11 per cent of which were potentially preventable, em phasizes the critical importance of infection control and aggressive p ulmonary toilet in the early care of injured patients.