Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-15T03:46:29.987Z Has data issue: false hasContentIssue false
  • English
  • Français

Trauma Severity Scoring Systems as Predictors of Nosocomial Infection

Published online by Cambridge University Press:  02 January 2015

Silom Jamulitrat ,
Montha Na Narong  and
Somchit Thongpiyapoom
Silom Jamulitrat*
Affiliation:
Department of Community Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
Montha Na Narong
Affiliation:
Infection Control Unit, Songklanagarind Hospital, Hat Yai, Songkla, Thailand
Somchit Thongpiyapoom
Affiliation:
Infection Control Unit, Songklanagarind Hospital, Hat Yai, Songkla, Thailand
*
Department of Community Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110, Thailand
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To describe the patterns of nosocomial infections in patients with traumatic injuries and to compare the associations between injury severity, derived from various severity scoring systems, and subsequent nosocomial infections.

Design:

Prospective observational study.

Setting:

A 750-bed university hospital serving as a medical school and referral center for the southern part of Thailand.

Participants:

All trauma patients admitted to the hospital for more than 3 days during 1996 to 1999 were eligible for this study.

Methods:

The severity of injuries was measured in terms of injury severity score (ISS), revised trauma score (RTS), new injury severity score (NISS), and trauma injury severity score (TRISS). Infections acquired during hospitalization were categorized using Centers for Disease Control and Prevention criteria. The association between severity of injury and nosocomial infection was examined with Poisson regression models.

Results:

There were 222 nosocomial infections identified among 146 patients, yielding an infection rate of 0.8 infections per 100 patient-days. Surgical-site infection was the most common site-specific infection, accounting for 31.1% of all infections. The incidence of intravenous catheter–related bloodstream infection was 1.6 infections per 100 catheter-days. The bladder catheter–related urinary tract infection rate was 2.8 infections per 100 catheter-days. The rate of ventilator-associated pneumonia was 3.2 infections per 100 ventilator-days. The incidence of infection correlated well with injury severity. The infection incidence rate ratios for one severity category increment of ISS, NISS, RTS, and TRISS were 1.65 (95% confidence interval [CI95, 1.42 to 1.92), 1.79 (CI95, 1.55 to 2.05), 1.64 (CI95, 1.43 to 1.88), and 1.32 (CI95, 1.14 to 1.52), respectively.

Conclusions:

Surgical-site infection was the most common site-specific nosocomial infection. The NISS might be the most appropriate severity scoring system for adjustment of infection rates in trauma patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 5 , May 2002 , pp. 268 - 273
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Vincent, JL, Bihari, DJ, Suter, PM, et al. The prevalence of nosocomial infection in an intensive care unit in Europe. JAMA 1995;274:639–644.Google Scholar
2.Wallace, WC, Cinat, M, Gornick, WB, Lekawa, ME, Wilson, SE. Nosocomial infections in the surgical intensive care unit: a difference between trauma and surgical patients. Am Surg 1999;65:987–990.CrossRefGoogle ScholarPubMed
3.Chaudry, IH, Ayala, A. Mechanism of increased susceptibility to infection following hemorrhage. Am J Surg 1993;165:59s–67s.CrossRefGoogle ScholarPubMed
4.van Saene, HKF, Stoutenbeek, CP, Zandstra, DF, Gilberston, AA, Murray, A, Hart, CA. Nosocomial infections in severely traumatized patients: magnitude of problem, pathogenesis, prevention and therapy. Acta Anaesthesiol Belg 1987;38:347–353.Google Scholar
5.Xu, YX, Ayala, A, Chaudry, IH. Prolonged immunodepression after trauma and hemorrhagic shock. J Trauma 1998;44:335–341.Google Scholar
6.Faist, E, Schinkel, C, Zimmer, S. Update on the mechanisms of immune suppression of injury and immune modulation. World J Surg 1996;20:454–549.CrossRefGoogle ScholarPubMed
7.Osler, T. Injury severity scoring: perspectives in development and future directions. Am J Surg 1993;165:43s–51s.Google Scholar
8.Baker, SP, O'Neill, B, Haddon, W Jr, Long, W. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187–196.Google Scholar
9.Champion, HR, Sacco, WJ, Copes, WS, Gann, DS, Gennarelli, TA, Flanagan, ME. A revision of the trauma score. J Trauma 1989;29:623–629.Google Scholar
10.Boyd, CR, Tolson, MA, Copes, WS. Evaluating trauma care: the TRISS method. J Trauma 1987;27:370–378.Google Scholar
11.Osler, T, Baker, SP, Lang, W. A modification of injury severity score that both improves accuracy and simplifies scoring. J Trauma 1997;43:922–926.CrossRefGoogle ScholarPubMed
12.Brenneman, FD, Boulanger, BR, McLellan, BA, Redelmeier, DA. Measuring injury severity: time for a change? J Trauma 1998;44:580–582.Google Scholar
13.Fife, D, Kraus, J. Infection as a contributory cause of death in patients hospitalized for motor vehicle trauma. Am J Surg 1988;155:278–283.CrossRefGoogle ScholarPubMed
14.Sauaia, A, Moore, FA, Moore, EE, et al. Epidemiology of trauma deaths: a reassessment. J Trauma 1995;38:185–193.Google Scholar
15.Keita-Perse, O, Gaynes, RP. Severity of illness scoring systems to adjust nosocomial infection rates: a review and commentary. Am J Infect Control 1996;24:429–434.Google Scholar
16.Hurr, H, Hawley, HB, Czachor, JS, Markert, RJ, McCarthy, MC. APACHE II and ISS scores as predictors of nosocomial infections in trauma patients. Am J Infect Control 1999;27:79–83.CrossRefGoogle ScholarPubMed
17.Cheadle, WG, Wilson, M, Hershman, MJ, Bergamini, D, Richardson, JD, Polk, HC. Comparison of trauma assessment scores and their use in prediction of infection and death. Ann Surg 1989;209:541–545.CrossRefGoogle ScholarPubMed
18.Bueno-Cavanillas, ARodriguez-Contreras, R, Lopez-Luque, A, Delgado-Rodriguez, M, Galves-Vargas, R. Usefulness of severity indices in intensive care medicine as a predictor of nosocomial infection risk. Intensive Care Medicine 1991;17:336–339.Google Scholar
19.Papia, G, McLellan, BA, El-Helou, P, Louie, M, Rachlis, A. Infection in hospitalized trauma patients: incidence, risk factors, and complications. J Trauma 1999;47:923–927.Google Scholar
20.Pories, SE, Gamelli, RL, Mead, PB, Goodwin, G, Harris, F, Vacek, P. The epidemiologic features of nosocomial infections in patients with trauma. Arch Surg 1991;126:97–99.CrossRefGoogle ScholarPubMed
21.Offner, PJ, Moore, EE, Biffl, WL. Male gender is a risk factor for major infections after surgery. Arch Surg 1999;134:935–940.Google Scholar
22.Agawal, N, Murphy, JG, Cayten, CG, Stahl, WM. Blood transfusion increases the risk of infection after trauma. Arch Surg 1993;128:171–176.CrossRefGoogle Scholar
23.Claridge, JA, Crabtree, TD, Pelletier, SJ, Butler, K, Sawyer, RG, Young, JS. Persistent occult hypoperfusion is associated with a significant increase in infection rate and mortality in major trauma patients. J Trauma 2000;48:8–14.Google Scholar
24.Edna, T-H, Bjerkeset, T. Association between blood transfusion and infection in injured patients. J Trauma 1992;33:659–661.Google Scholar
25.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128–140.Google Scholar
26.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992;20:271–274.Google Scholar
27.Association for the Advancement of Automotive Medicine. The Abbreviated Injury Scale, 1990 revision. Des Plaines, IL: Association for the Advancement of Automotive Medicine; 1990.Google Scholar
28.Champion, HR, Sacco, WJ, Copes, WS. Injury severity score again. J Trauma 1995;38:94–95.Google Scholar
29.Kleinbaum, DG, Kupper, LL, Muller, KE. Maximum likelihood methods. In: Kleinbaum, DG, Kupper, LL, Muller, KE, eds. Applied Regression Analysis and Other Multivariate Methods, 2nd ed. Pacific Grove, CA: Duxbury Press; 1988:497–512.Google Scholar
30.Delgado, RM, Bueno, CA, Lopez, GR, et al. Hospital stay length as an effect modifier of other risk factors for nosocomial infection. Eur J Epidemiol 1990;6:34–39.CrossRefGoogle Scholar
31.Champion, HR, Copes, WS, Sacco, WJ, et al. A new characterization of injury severity. J Trauma 1990;30:539–546.Google Scholar