Yun Heather C, Blackbourne Lorne H, Jones John A, Holcomb John B, Hospenthal Duane R, Wolf Steven E, Renz Evan M, Murray Clinton K
San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
Mil Med. 2010 May;175(5):317-23. doi: 10.7205/milmed-d-09-00098.
Infectious complications are reported frequently in combat trauma patients treated at military hospitals. Infections in 4566 noncombat related trauma patients treated at a military trauma center were retrospectively reviewed from 1/2003 to 5/2007 using registry data. Burns, penetrating, and blunt trauma accounted for 17%, 19%, and 64%, respectively; the median age was 38 and 22% were female. Pulmonary infections were present in 4.2% of patients, 2.4% had cellulitis and wound infections, 2.2% urinary infections, and 0.7% sepsis. On univariate analysis, infected patients were more likely to be admitted to the ICU, have longer ICU and hospital lengths of stay (LOS), and to die (p < 0.05). Multivariate analysis revealed associations between infection and hospital LOS, preexisting medical conditions, and lower Glasgow Coma Scale in nonburned patients. In burned patients, infection was associated with total body surface area burned and preexisting conditions (p < 0.01). Enhanced infection control in targeted trauma populations may improve outcomes.
在军队医院接受治疗的战斗创伤患者中,感染并发症的报告屡见不鲜。利用登记数据,对2003年1月至2007年5月在一家军队创伤中心接受治疗的4566例非战斗相关创伤患者的感染情况进行了回顾性分析。烧伤、穿透伤和钝性创伤分别占17%、19%和64%;年龄中位数为38岁,女性占22%。4.2%的患者发生肺部感染,2.4%发生蜂窝织炎和伤口感染,2.2%发生尿路感染,0.7%发生败血症。单因素分析显示,感染患者更有可能入住重症监护病房(ICU),在ICU和医院的住院时间更长,且死亡风险更高(p<0.05)。多因素分析显示,在非烧伤患者中,感染与住院时间、既往病史以及较低的格拉斯哥昏迷量表评分相关。在烧伤患者中,感染与烧伤总面积和既往病史相关(p<0.01)。在目标创伤人群中加强感染控制可能会改善治疗效果。