Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, MA, USA; Department of Trauma Surgery, University Medical Center Utrecht, PO Box 85500, 3508GA Utrecht, the Netherlands.
Division of Trauma, Emergency Surgery & Surgical Critical Care Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Am J Surg. 2024 Dec;238:115983. doi: 10.1016/j.amjsurg.2024.115983. Epub 2024 Sep 18.
Early identification of patients at risk of nosocomial pneumonia enables the opportunity for preventative measures, which may improve survival and reduce costs. Therefore, this study aimed to externally validate an existing prediction model (issued by Croce et al.) to predict nosocomial pneumonia in patients admitted to US level-1 trauma centers.
A retrospective cohort study including patients admitted to level-1 trauma centers and registered in the TQIP, a US nationwide trauma registry, admitted between 2013-2015 and 2017-2019. The main outcome was total nosocomial pneumonia for the first period and ventilator-associated pneumonia (VAP) for the second. Model discrimination and calibration were assessed before and after recalibration.
The study comprised 902,231 trauma patients (N = 180,601; N = 721,630), with a median age of 52 in both periods, 64-65 % male, and approximately 90 % sustaining blunt traumatic injury. The median Injury Severity Scores were 13 (2013-2015) versus 9 (2017-2019); median Glasgow Coma Scale scores were 15. Nosocomial pneumonia incidence was 4.4 %, VAP incidence was 0.7 %. The original model demonstrated good to excellent discrimination for both periods (c-statistic 0.84, 95%CI 0.83-0.84; c-statistic 0.92, 95%CI 0.91-0.92). After recalibration, discriminatory capacity and calibration for the lower predicted probabilities improved.
The Croce model can identify patients admitted to US level-1 trauma centers at risk of total nosocomial pneumonia and VAP. Implementing (modified) Croce models in route trauma clinical practice could guide judicious use of preventative measures and prescription of additional non-invasive preventative measures (e.g., increased monitoring, pulmonary physiotherapy) to decrease the occurrence of nosocomial pneumonia in at-risk patients.
早期识别医院获得性肺炎风险患者可提供预防措施的机会，这可能改善患者的生存率并降低成本。因此，本研究旨在对 Croce 等人提出的预测模型进行外部验证，以预测美国一级创伤中心收治的患者发生医院获得性肺炎的风险。
本研究采用回顾性队列研究设计，纳入 2013-2015 年和 2017-2019 年期间登记在 TQIP（美国全国性创伤登记处）中的美国一级创伤中心收治的患者。主要结局为第一时期的总医院获得性肺炎和第二时期的呼吸机相关性肺炎（VAP）。在重新校准前后评估模型的区分度和校准度。
该研究纳入了 902231 例创伤患者（N=180601，N=721630），两个时期的中位年龄均为 52 岁，64%-65%为男性，约 90%为钝性创伤。损伤严重度评分的中位数分别为 13 分（2013-2015 年）和 9 分（2017-2019 年）；格拉斯哥昏迷评分的中位数为 15 分。医院获得性肺炎的发生率为 4.4%，呼吸机相关性肺炎的发生率为 0.7%。原始模型在两个时期均表现出良好到优秀的区分度（c 统计量 0.84，95%CI 0.83-0.84；c 统计量 0.92，95%CI 0.91-0.92）。重新校准后，较低预测概率的区分度和校准度得到了改善。
Croce 模型可用于识别美国一级创伤中心收治的发生总医院获得性肺炎和 VAP 的风险患者。在创伤临床实践中实施（改良）Croce 模型可能有助于合理使用预防措施，并开具额外的非侵入性预防措施（例如，增加监测、肺理疗），以降低高危患者发生医院获得性肺炎的风险。
