Pneumonia in severely injured patients with thoracic trauma: results of a retrospective observational multi-centre study

Sebastian Wutzler†,
Felix M. Bläsius†Email author View ORCID ID profile,
Philipp Störmann,
Thomas Lustenberger,
Michael Frink,
Marc Maegele,
Matthias Weuster,
Jörg Bayer,
Michael Caspers,
Andreas Seekamp,
Ingo Marzi,
Hagen Andruszkow† and
Frank Hildebrand†

†Contributed equally

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine201927:31

https://doi.org/10.1186/s13049-019-0608-4

Received: 5 November 2018
Accepted: 28 February 2019
Published: 14 March 2019

Abstract

Background

While the incidence and aspects of pneumonia in ICU patients has been extensively discussed in the literature, studies on the occurrence of pneumonia in severely injured patients are rare. The aim of the present study is to elucidate factors associated with the occurrence of pneumonia in severely injured patients with thoracic trauma.

Setting

Level-I University Trauma Centres associated with the TraumaRegister DGU®.

Methods

A total of 1162 severely injured adult patients with thoracic trauma documented in the TraumaRegister DGU® (TR-DGU) were included in this study. Demographic data, injury severity, duration of mechanical ventilation (MV), duration of ICU stay, occurrence of pneumonia, bronchoalveolar lavage, aspiration, pathogen details, and incidences of mortality were evaluated. Statistical evaluation was performed using SPSS (Version 25.0, SPSS, Inc.) software.

Results

The overall incidence of pneumonia was 27.5%. Compared to patients without pneumonia, patients with pneumonia had sustained more severe injuries (mean ISS: 32.6 vs. 25.4), were older (mean age: 51.3 vs. 47.5) and spent longer periods under MV (mean: 368.9 h vs. 114.9 h). Age, sex (male), aspiration, and duration of MV were all independent predictors for pneumonia occurrence in a multivariate analysis. The cut-off point for duration of MV that best discriminated between patients who would and would not develop pneumonia during their hospital stay was 102 h. The extent of thoracic trauma (AISthorax), ISS, and presence of pulmonary comorbidities did not show significant associations to pneumonia incidence in our multivariate analysis. No significant difference in mortality between patients with and without pneumonia was observed.

Conclusions

Likelihood of pneumonia increases with age, aspiration, and duration of MV. These parameters were not found to be associated with differences in outcomes between patients with and without pneumonia. Future studies should focus on independent parameters to more clearly identify severely injured subgroups with a high risk of developing pneumonia.