A RISK ANALYSIS OF PULMONARY COMPLICATIONS FOLLOWING MAJOR TRAUMA

Varying institutional definitions and degrees of surveillance limit aw areness of the true incidence of posttraumatic pulmonary complications . Prospective review with standardized definitions of 25 categories of pulmonary complications was applied to a university level I trauma se rvice over 3 years to establish the true incidence. Potential injury-r elated predictors of individual complications were determined using mu ltiple logistic regression analysis and adjusted odds ratios were calc ulated, thereby controlling for the effect of other covariants. Signif icance was attributed to p < 0.05. Of 3289 patients meeting MTOS crite ria, pulmonary complications occurred in 368 (11.2%). Pulmonary compli cations account for one third of all disease complications. Significan t associations with pneumonia included age, the presence of shock on a dmission, significant head injury, and surgery to the head and chest. Significant risk for atelectasis occurred in patients with blunt injur y mechanism, ISS > 16, shock on admission, and severe head injury. Ris ks for development of respiratory failure included age > 55 years, the mechanism of ''pedestrian struck'', and the presence of significant h ead injury. Risk factors for ARDS included surgery to the head and a T rauma Score < 13 on arrival. Significant predictors for pulmonary embo lism included ISS > 16, shock on admission, and extremity and pelvis i njuries. The true incidence of pulmonary complications is established with this kind of analysis and focuses attention on (1) groups at high risk for developing complications, (2) groups for Which current thera peutic modalities are still ineffective, and (3) defining the need to refocus on prospective research rather than ineffective processes of c are.