Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center, Cologne, Germany.
Crit Care Med. 2011 Apr;39(4):621-8. doi: 10.1097/CCM.0b013e318206d3df.
The objectives of this study were 1) to assess potential changes in the incidence and outcome of sepsis after multiple trauma in Germany between 1993 and 2008 and 2) to evaluate independent risk factors for posttraumatic sepsis.
Retrospective analysis of a nationwide, population-based prospective database, the Trauma Registry of the German Society for Trauma Surgery.
A total of 166 voluntarily participating trauma centers (levels I-III).
Patients registered in the Trauma Registry of the German Society for Trauma Surgery between 1993 and 2008 with complete data sets who presented with a relevant trauma load (Injury Severity Score of ≥ 9) and were admitted to an intensive care unit (n = 29,829).
None.
Over the 16-yr study period, 10.2% (3,042 of 29,829) of multiply injured patients developed sepsis during their hospital course. Annual data were summarized into four subperiods: 1993-1996, 1997-2000, 2001-2004, and 2005-2008. The incidences of sepsis for the four subperiods were 14.8%, 12.5%, 9.4%, and 9.7% (p < .0001), respectively. In-hospital mortality for all trauma patients decreased for the respective subperiods (16.9%, 16.0%, 13.7%, and 11.9%; p < .0001). For the subgroup of patients with sepsis, the mortality rates were 16.2%, 21.5%, 22.0%, and 18.2% (p = .054), respectively. The following independent risk factors for posttraumatic sepsis were calculated from a multivariate logistic regression analysis: male gender, age, preexisting medical condition, Glasgow Coma Scale score of ≤ 8 at scene, Injury Severity Score, Abbreviated Injury ScaleTHORAX score of ≥ 3, number of injuries, number of red blood cell units transfused, number of operative procedures, and laparotomy.
The incidence of sepsis decreased significantly over the study period; however, in this decade the incidence remained unchanged. Although overall mortality from multiple trauma has declined significantly since 1993, there has been no significant decrease of mortality in the subgroup of septic trauma patients. Thus, sepsis has remained a challenging complication after trauma during the past 2 decades. Recognition of the identified risk factors may guide early diagnostic workup and help to reduce septic complications after multiple trauma.
本研究的目的是 1）评估 1993 年至 2008 年期间德国多发伤后脓毒症的发病率和结局的潜在变化，2）评估创伤后脓毒症的独立危险因素。
德国创伤外科学会创伤数据库的全国性、基于人群的回顾性分析。
166 个自愿参与的创伤中心（I-III 级）。
1993 年至 2008 年间在德国创伤外科学会创伤数据库登记，具有完整数据集，且具有相关创伤负荷（损伤严重程度评分≥9）并入住重症监护病房的患者（n=29829）。
无。
在 16 年的研究期间，10.2%（3042/29829）的多发伤患者在住院期间发生脓毒症。每年的数据汇总为四个亚组：1993-1996 年、1997-2000 年、2001-2004 年和 2005-2008 年。四个亚组的脓毒症发生率分别为 14.8%、12.5%、9.4%和 9.7%（p<0.0001）。所有创伤患者的院内死亡率在相应的亚组中均下降（16.9%、16.0%、13.7%和 11.9%；p<0.0001）。对于脓毒症患者亚组，死亡率分别为 16.2%、21.5%、22.0%和 18.2%（p=0.054）。多变量逻辑回归分析计算出创伤后脓毒症的以下独立危险因素：男性、年龄、既往疾病、现场格拉斯哥昏迷评分≤8、损伤严重程度评分、简明损伤评分胸≥3、损伤数量、输红细胞单位数量、手术次数和剖腹术。
研究期间脓毒症的发病率显著下降；然而，在这十年中，发病率保持不变。尽管自 1993 年以来，多发伤的总体死亡率显著下降，但脓毒症创伤患者亚组的死亡率没有显著下降。因此，脓毒症在过去 20 年一直是创伤后的一个具有挑战性的并发症。识别出的危险因素可能有助于早期诊断，并有助于减少多发伤后的脓毒症并发症。
