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Ventilator-associated pneumonia rates at major trauma centers compared with a national benchmark: A multi-institutional study of the AAST

Michetti, Christopher P. MD; Fakhry, Samir M. MD; Ferguson, Pamela L. PhD; Cook, Alan MD; Moore, Forrest O. MD; Gross, Ronald MDthe AAST Ventilator-Associated Pneumonia Investigators

The Journal of Trauma and Acute Care Surgery: May 2012 - Volume 72 - Issue 5 - p 1165–1173
doi: 10.1097/TA.0b013e31824d10fa
AAST 2011 Plenary Papers
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BACKGROUND: Ventilator-associated pneumonia (VAP) rates reported by the National Healthcare Safety Network (NHSN) are used as a benchmark and quality measure, yet different rates are reported from many trauma centers. This multi-institutional study was undertaken to elucidate VAP rates at major trauma centers.

METHODS: VAP rate/1,000 ventilator days, diagnostic methods, institutional, and aggregate patient data were collected retrospectively from a convenience sample of trauma centers for 2008 and 2009 and analyzed with descriptive statistics.

RESULTS: At 47 participating Level I and II centers, the pooled mean VAP rate was 17.2 versus 8.1 for NHSN (2006–2008). Hospitals' rates were highly variable (range, 1.8–57.6), with 72.3% being above NHSN′s mean. Rates differed based on who determined the rate (trauma service, 27.5; infection control or quality or epidemiology, 11.9; or collaborative effort, 19.9) and the frequency with which VAP was excluded based on aspiration or diagnosis before hospital day 5. In 2008 and 2009, blunt trauma patients had higher VAP rates (17.3 and 17.6, respectively) than penetrating patients (11.0 and 10.9, respectively). More centers used a clinical diagnostic strategy (57%) than a bacteriologic strategy (43%). Patients with VAP had a mean Injury Severity Score of 28.7, mean Intensive Care Unit length of stay of 20.8 days, and a 12.2% mortality rate. 50.5% of VAP patients had a traumatic brain injury.

CONCLUSIONS: VAP rates at major trauma centers are markedly higher than those reported by NHSN and vary significantly among centers. Available data are insufficient to set benchmarks, because it is questionable whether any one data set is truly representative of most trauma centers. Application of a single benchmark to all centers may be inappropriate, and reliable diagnostic and reporting standards are needed. Prospective analysis of a larger data set is warranted, with attention to injury severity, risk factors specific to trauma patients, diagnostic method used, VAP definitions and exclusions, and reporting guidelines.

LEVEL OF EVIDENCE: III, prognostic study.

Falls Church, Virginia

From the Department of Surgery, Inova Regional Trauma Center, Falls Church, Virginia; and the Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.

Submitted: September 8, 2011, Revised: January 11, 2012, Accepted: January 19, 2012.

Presented at the 70th Annual Meeting of the American Association for the Surgery of Trauma, September 14, 2011, Chicago, Illinois.

Address for reprints: Christopher P. Michetti, MD, Inova Regional Trauma Center, 3300 Gallows Road, Falls Church, VA, 22042; email: christopher.michetti@inova.org.

© 2012 Lippincott Williams & Wilkins, Inc.