Abstract
Trauma patients are at risk of repeated hospital-acquired infections, however predictive scores aiming to identify susceptibility to such infections are lacking. The objective of this study was to investigate whether commonly employed disease-severity scores can successfully predict susceptibility to multiple independent infectious episodes (MIIEs) among trauma patients. A secondary analysis of data derived from the prospective, longitudinal study “Inflammation and the Host Response to Injury” (“Glue Grant”) was performed. 1,665 trauma patients, older than 16, were included. Patients who died within seven days from the time of injury were excluded. Five commonly used disease-severity scores [Denver, Marshall, Acute Physiology and Chronic Health Evaluation II (APACHE II), Injury Severity Score (ISS), and New Injury Severity Score (NISS)] were examined as independent predictors of susceptibility to MIIEs. The latter was defined as two or more independent infectious episodes during the index hospital stay. Multivariable logistic regression was used for the statistical analysis. 22.58% of the population was found to be susceptible to MIIEs. Denver and Marshall scores were highly predictive of the MIIE status. For every 1-unit increase in the Denver or the Marshall score, there was a respective 15% (Odds Ratio:1.15; 95% CI: 1.07–1.24; p < 0.001) or 16% (Odds Ratio:1.16; 95% CI: 1.09–1.24; p < 0.001) increase in the odds of MIIE occurrence. APACHE II, ISS, and NISS were not independent predictors of susceptibility to MIIEs. In conclusion, the Denver and Marshall scores can reliably predict which trauma patients are prone to MIIEs, prior to any clinical sign of infection. Early identification of these individuals would potentially allow the implementation of rapid, personalized, preventative measures, thus improving patient outcomes and reducing healthcare costs.
Highlights
Traumatic injury has long been identified as one of the leading causes of morbidity and mortality worldwide [1]
This study aims to evaluate whether organ dysfunction and trauma severity, assessed by commonly employed disease-severity scoring systems, could successfully predict patient susceptibility to multiple independent infectious episodes (MIIEs) during their hospital stay
Our study shows that the Denver and Marshall scores, which are used to assess the severity of organ failure in the setting of traumatic injury, can accurately predict susceptibility to MIIEs after trauma, even when assigned much earlier than infection occurrence
Summary
Traumatic injury has long been identified as one of the leading causes of morbidity and mortality worldwide [1]. The rates of hospital-acquired infections are high in the trauma. Denver and Marshall scores predict infection susceptibility in trauma patients recipient’s IRB letter of approval and IRB-approved protocol or application. In the event that an individual and institution does not have an internal IRB or ethical committee, the individual is required to obtain IRB approval from an independent IRB, such as the Western IRB (WIRB). Upon approval of the Steering Committee, the requested data will be viewable under the recipient’s user name and password. Investigators that are interested to access the database can go to the Glue Grant public web site at http://www.gluegrant.org/ for a link to information about TRDB Con. We confirm that other researchers would be able to access the data set in the same manner as the authors, and the authors did not have any special access privileges that others would not have
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