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Late Outcomes of Trauma Patients With Infections During Index Hospitalization

Czaja, Angela S. MD, MSc; Rivara, Frederick P. MD, MPH; Wang, Jin PhD; Koepsell, Thomas MD, MPH; Nathens, Avery B. MD, MPH, PhD; Jurkovich, Gregory J. MD; Mackenzie, Ellen PhD

The Journal of Trauma: Injury, Infection, and Critical Care: October 2009 - Volume 67 - Issue 4 - p 805-814
doi: 10.1097/TA.0b013e318185e1fb
Original Article

Background: Injured patients have significant risk of infection during initial hospitalization. We hypothesized that infected trauma patients would have worse late outcomes.

Methods: From 69 centers, patients with moderate-severe injuries and at least one selected infection during hospitalization were compared with those without an infection. Outcomes measured at 3 months and 12 months postinjury included death, subscales on the Medical Outcomes Short Form Health Survey (SF-36), Revised Center for Epidemiologic Studies Depression Scale, the cognitive subscale of the Functional Capacity Index, the Mobility and Fine Motor subscales of the Musculoskeletal Function Assessment, return to work, and healthcare utilization postdischarge.

Results: Of 4,732 patients, 668 had ≥1 infection. Patients with hospitalizations complicated by infection had a higher risk of death within 1 year after injury, hazard ratio 1.56 (95%confidence interval [CI] 1.13–2.15). Surviving patients with infections had lower SF-36 physical function scores and patients older than 65 years also demonstrated lower scores in general health, vitality, emotional and social function. Postdischarge, infected patients were more likely to have repeat hospitalizations, need home health services (relative risk [RR] 1.19, 95% CI 1.03–1.37 and RR 1.68, 95% CI 1.12–2.52, respectively) and require 3 more hours of care from family/friends per month. They were also less likely to have returned to work (odds ratio 1.67, 95% CI 1.20–2.32). However, infected patients were at less risk of being depressed 12 months postinjury (RR 0.77, 95% CI 0.62–0.97).

Conclusions: Trauma patients with an infection during hospitalization demonstrate worsened functional status and increased healthcare usage up to a year after injury compared with those without an infection. Future interventions need to target decreasing infection risk as well as close follow-up after discharge.

Critical Care Division (A.S.C.), Department of Pediatrics, University of Colorado, Aurora, Colorado; Harborview Injury Prevention and Research Center (F.P.R., J.W., T.K.), University of Washington, Seattle, Washington; Department of Epidemiology (T.K.), University of Washington, Seattle, Washington; Division of General Surgery (A.B.), St. Michael’s Hospital and the Department of Surgery, University of Toronto, Toronto, Canada; Department of Surgery (G.J.J.), University of Washington, Seattle, Washington; and Center for Injury Research and Policy (E.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Submitted for publication March 17, 2008.

Accepted for publication July 7, 2008.

Supported by a grant (R49/CCR316840) from the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention and a grant (RO1/AG20361) from the National Institute on Aging of the NIH.

Address for reprints: Angela S. Czaja, MD, MSc, Critical Care, Mail Stop 8414, ED 2 South, Room 4126, 13121 E 17th Avenue, PO Box 6508, Aurora, CO 80045; email:

© 2009 Lippincott Williams & Wilkins, Inc.