A RISK ANALYSIS OF STRESS ULCERATION AFTER TRAUMA

Prophylaxis for stress ulceration is considered standard care for most critically ill patients, but may be overutilized, We determined the i ncidence of stress ulceration in 33,637 major trauma patients treated in a regionalized trauma system from 1985 to 1991 using trauma registr y data and chart review, Injury-related risk factors for stress ulcera tion and other associated infectious and organ failure complications w ere identified by regression analysis, Clinical stress ulceration deve loped in 57 patients (0.17%) despite prophylaxis, Eighteen patients (0 ,05%) developed severe ulceration with either gastroduodenal perforati on (3 patients) or a > 2 U blood transfusion requirement (16 patients) , Independent risk factors with odds ratios (OR) were identified as fo llows: Injury Severity Score (ISS) greater than or equal to 16, OR = 1 2.6; spinal cord injury, OR = 2.0; and age > 55, OR = 2.4, Other serio us complications, including pneumonia, sepsis, and organ failure (adul t respiratory distress syndrome and renal and hepatic failure), were s ignificantly associated with the development of stress ulceration, Cli nically significant stress ulceration after trauma is uncommon, but oc curs despite prophylaxis, Severe injury (ISS > 16) and spinal cord inj ury were identified as independent injury-related risk factors, All pa tients with severe ulceration had either one of these injury-related r isk factors or a significant infectious complication or organ failure, Standard prophylaxis may be inadequate in high-risk patients, who sho uld be targeted for increased surveillance and aggressive prophylaxis. On the other hand, routine prophylaxis in low-risk patients may be ov erutilized.