Kobes T, Sweet A A R, IJpma F F A, Leenen L P H, Houwert R M, van Wessem K J P, Groenwold R H H, van Baal M C P M
Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Department of Trauma Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Arch Orthop Trauma Surg. 2024 Dec 27;145(1):100. doi: 10.1007/s00402-024-05672-0.
Nosocomial pneumonia is common in trauma patients and associated with an adverse prognosis. We recently externally validated and recalibrated an existing formula to predict nosocomial pneumonia risk. Identifying more potential predictors could aid in a more accurate prediction of nosocomial pneumonia risk in level-1 trauma patients. This study aims to identify predictors of nosocomial pneumonia in level-1 trauma patients available in the emergency department or shortly after, and examine their added predictive value to an existing prediction model by Croce.
This retrospective cohort study included all consecutive trauma patients (≥ 16 years) admitted for > 24 h to our level-1 trauma center in 2017. Excluded were patients with active infection upon admission, transfer from another hospital, or in-hospital mortality < 48 h. Multiple imputations were used for missing values. Multivariable logistic regression analysis and Ridge penalization were performed to assess the association of predictors with nosocomial pneumonia and evaluate predictor stability. The predictive performance in addition to the existing prediction model was evaluated as well.
The study included 809 patients [median age 51 (IQR 32-68) years, 66.9% male, median ISS 10 (5-17), median GCS score 15 (14-15)]. Pneumonia incidence was 10.6% (n = 86). Age (OR 1.03 per year), ISS (OR 1.10 per point), GCS score (OR 0.91 per point), pulmonary contusion (OR 2.77), male sex (OR 1.36), hypertension (OR 1.86), diabetes (OR 1.20), number of rib fractures (OR 1.05 per fractured rib), and thoracic spine fracture (OR 1.51) were found to be predictors of nosocomial pneumonia. All variables showed added predictive value in addition to the existing model.
Patient history, injury severity, thoracic trauma, and traumatic brain injury are essential components of nosocomial pneumonia prediction and add to the predictive value of an existing model. Our results further build a basis for more accurate prediction.
Level III, prognostic/epidemiological.
医院获得性肺炎在创伤患者中很常见，且与不良预后相关。我们最近对一个现有的预测医院获得性肺炎风险的公式进行了外部验证和重新校准。识别更多潜在的预测因素有助于更准确地预测一级创伤患者发生医院获得性肺炎的风险。本研究旨在识别一级创伤患者在急诊科或入院后不久即可获得的医院获得性肺炎的预测因素，并检验它们对Croce提出的现有预测模型的额外预测价值。
这项回顾性队列研究纳入了2017年在我们一级创伤中心连续住院超过24小时的所有创伤患者（≥16岁）。排除入院时存在活动性感染、从其他医院转入或住院48小时内死亡的患者。对缺失值采用多重填补法。进行多变量逻辑回归分析和岭回归惩罚以评估预测因素与医院获得性肺炎的关联，并评估预测因素的稳定性。还评估了在现有预测模型基础上的预测性能。
该研究纳入了809例患者[中位年龄51（四分位间距32 - 68）岁，男性占66.9%，中位损伤严重度评分（ISS）为10（5 - 17），中位格拉斯哥昏迷量表（GCS）评分为15（14 - 15）]。肺炎发生率为10.6%（n = 86）。年龄（每年OR 1.03）、ISS（每分OR 1.10）、GCS评分（每分OR 0.91）、肺挫伤（OR 2.77）、男性（OR 1.36）、高血压（OR 1.86）、糖尿病（OR 1.20）、肋骨骨折数量（每根骨折肋骨OR 1.05）和胸椎骨折（OR 1.51）被发现是医院获得性肺炎的预测因素。除现有模型外，所有变量均显示出额外的预测价值。
患者病史、损伤严重程度、胸部创伤和创伤性脑损伤是医院获得性肺炎预测的重要组成部分，并增加了现有模型的预测价值。我们的结果进一步为更准确的预测奠定了基础。
三级，预后/流行病学。
