Emergency department length of stay: a major risk factor for pneumonia in intuhated blunt trauma patients
Emergency department length of stay: a major risk factor for pneumonia in intuhated blunt trauma patients
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DOI：
10.1097/ta.0b013e31805d8f6b
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发表时间：
2007-07-01
影响因子：
--
通讯作者：
Reilly, Patrick M.
中科院分区：
文献类型：
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作者：
Carr, Brendan G.;Kaye, Adam J.;Reilly, Patrick M.
背景：肺炎常见于插管病人，病态，有时甚至致死。肺炎预防策略在重症监护病房取得了成功，受到了好评，具有成本效益和有效性。创伤患者通常在院前或急诊科(ED)环境中紧急插管。在全国范围内，医院拥挤导致急诊室住院时间(LOS)延长。方法：这是一项为期两年的回顾性病例对照研究，研究对象是在城市I级创伤中心就诊的急诊插管的钝性创伤患者的肺炎风险。向创伤登记处查询人口统计学和临床信息。所有在院前或急诊室插管并发生肺炎的患者均被确定为病例。确定了一组年龄、损伤严重程度评分、胸部缩写损伤评分(AIS)和AIS头部未发生肺炎的匹配对照组。结果：我们确定了509例急诊插管的钝性创伤患者。在这些人中，33人患上了肺炎，可以与类似的对照组相匹配。病例受试者的平均年龄为44.6岁(+/-24.3)，平均损伤严重程度评分为32.7(+/-9.4)，平均胸部AIS为1.5(+/-1.6)，平均头部AIS为4.4(+/-1.2)。病例组的ED LOS显著长于对照组(281.3分钟对214.0分钟，P<；0.05)。每小时发生肺炎的风险增加约20%。结论：在急诊插管的钝性创伤患者中，ED LOS增加是肺炎的独立危险因素。呼吸机相关性肺炎干预在重症监护病房取得成功，应在医院病程早期实施，并应努力将医院拥挤和ED LOS降至最低。
Background: Pneumonia occurs commonly in intubated patients and is morbid and occasionally mortal. Pneumonia prevention strategies have been successful in the intensive care unit and are favorably regarded, cost effective, and efficacious. Trauma patients are often intubated emergently in the prehospital or emergency department (ED) setting. Nationwide, hospital crowding has resulted in prolonged ED length of stay (LOS). We sought to study the association between prolonged ED LOS and rates of pneumonia.Methods: This was a 2-year retrospective case-control study of pneumonia risk among blunt trauma patients presenting to an urban Level I trauma center who were emergently intubated. The trauma registry was queried for demographic and clinical information. All patients who were intubated prehospital or in the ED and developed pneumonia were identified as cases. A group of matched controls with equivalent age, injury severity score, abbreviated injury score (AIS) chest, and AIS head who did not develop pneumonia were identified. A comparison of ED LOS between the two groups was assessed using conditional logistic regression.Results: We identified 509 emergently intubated blunt trauma patients. Of these, 33 developed pneumonia and could be matched with comparable controls. The case subjects had a mean age of 44.6 (+/- 24.3), a mean injury severity score of 32.7 (+/- 9.4), a mean chest AIS of 1.5 (+/- 1.6), and a mean head AIS of 4.4 (+/- 1.2). The ED LOS for the cases was significantly longer than that for the controls (281.3 minutes vs. 214.0 minutes, p < 0.05). Each hour increased the risk of developing pneumonia by approximately 20%.Conclusions: In blunt trauma patients who are emergently intubated, increased ED LOS is an independent risk factor for pneumonia. Ventilator associated pneumonia interventions, successful in the intensive care unit, should be implemented early in the hospital course, and efforts should be made to minimize hospital crowding and ED LOS.