86. Ventilator-Associated Pneumonia in Trauma Intensive Care Unit, a Dilemma in Quality Metrics

Abstract

BackgroundVentilator-associated pneumonia (VAP) definition remains controversial. Ventilator-associated event (VAE) and probable/possible VAPs are reported to the National Healthcare Network (NHSN). In trauma patients, VAPs are also reported to the Trauma Quality Improvement Project (TQIP) utilizing the National Trauma Data Bank (NTDB)’s definition.MethodsWe reviewed all VAPs reported to NHSN and TQIP in trauma patients at the University of Nebraska Medical Center between January 1, 2015 and June 30, 2018. The primary objective was to determine the discordance rates between NHSN and NTDB definitions. VAPs identified by both NHSN+NTDB considered concordant; if identified by only one definition, considered discordant. Secondary objectives were mortality, intensive care unit (ICU) length of stay (LOS), and ventilator (vent) days. Fisher’s exact test and the Kruskal–Wallis test were used where appropriate; P < 0.05 = statistical significance.ResultsIn total, 998 patients had 5,624 days of vent support during the study period. One hundred and one patients were diagnosed with VAP. The median age was 43 years (range 2–92), median vent days were 14 days (range 3–128), and median ICU LOS was 16 days (range 6–47). Of the 101 patients, 28 (27%) met VAP definition by NHSN and 88 (87%) by NTDB. Of the 101 patients, 15 (15%) were concordant and 85 (85%) were discordant. Cumulative all-cause mortality was 23/101 (23%). Composite analysis showed mortality 5/15 (33%) in concordant group, 3/13 (23%) in NHSN group, and 15/73 (20%) in NTDB group (P = 0.52). Median vent days between concordant, NHSN, and NTDB groups were 14 days, 16 days, and 14 days, respectively (P = 0.71). Median ICU LOS was 17 days in concordant, 21 days in NHSN, and 14 days in NTDB group (P = 0.094). Similarly, comparison of NHSN VAE with NTDB VAP definition showed 67/101 (66%) were discordant. There was no statistically significant difference in mortality between concordant (NHSN VAE+NDTB VAP) 9/34 (26%), NHSN VAE 3/13 (23%), and NTDB VAP 11/54 (20%) (P = 0.84).ConclusionOur study showed very high discordant (85%) reporting of VAP to different agencies. No difference in mortality, ICU LOS, and vent days was noted. The high discordance of reported VAPs results in inconsistency in quality metrics and hinders initiatives to decrease VAPs depending on which definition is followed. Improved standardization is needed. Disclosures All Authors: No reported Disclosures.