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Witnessed aspiration in trauma: Frequent occurrence, rare morbidity—A prospective analysis

Benjamin, Elizabeth MD, PhD; Haltmeier, Tobias MD; Chouliaras, Konstantinos MD; Siboni, Stefano MD; Durso, Joseph; Inaba, Kenji MD; Demetriades, Demetrios MD, PhD

Journal of Trauma and Acute Care Surgery: December 2015 - Volume 79 - Issue 6 - p 1030–1037
doi: 10.1097/TA.0000000000000704
WTA Plenary Papers

BACKGROUND Aspiration events (AEs) are a well-recognized complication in trauma patients and have traditionally been considered a risk factor for pneumonia. Despite this, there is no consensus on the incidence or clinical significance of AE in the trauma population.

METHODS All patients admitted as trauma team activations at our Level I trauma center who were intubated in the field or on arrival from September 2013 to August 2014 were prospectively collected. Field and admission data including witnessed AEs were analyzed. Additional hospital data included imaging, associated injuries, laboratory, and clinical data. Early respiratory failure, pneumonia, and hospital mortality were collected.

RESULTS During the study period, 228 patients met inclusion criteria. Median age was 35.5 years, and Injury Severity Score (ISS) was 21.0. Overall, 58 patients (25.4%) had witnessed AEs. Patients with AE had significantly higher ISS (26.0 vs. 17.0, p = 0.027) and lower Glasgow Coma Scale (GCS) score on admission (median, 4.0 vs. 7.0; p = 0.003), despite similar field GCS score (p = 0.946). Body mass index (median, 27.2 vs. 26.2; p = 0.374) and intoxication rates (86.2% vs. 83.5%, p = 0.835) were similar between groups. Early pneumonia and respiratory failure were rare in all patients and were not higher in those with AE. Although mortality was higher after AE in patients who died directly after admission (51.7% vs. 30.0%, p = 0.004), in patients who survived to intensive care unit admission, there was no longer a difference between groups and aspiration was not an independent predictor of mortality (p = 0.107) on multivariable regression analysis.

CONCLUSION The rate of aspiration in trauma is high and more likely to occur in patients with increased injury burden or depressed GCS score. In patients who survive past admission, early pneumonia rates are similar, regardless of AE. These data suggest that aspiration is a marker of severe illness and is associated with but not an independent predictor of mortality.

LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III.

From the Division of Trauma and Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California.

Submitted: February 15, 2015, Revised: March 18, 2015, Accepted: March 25, 2015, Published online: August 28, 2015.

This study was presented at the 45th annual meeting of the Western Trauma Association, March 1–6, 2015, in Telluride, Colorado.

Address for reprints: Elizabeth Benjamin, MD, PhD, Los Angeles County + University of Southern California Medical Center, 2051 Marengo St, Inpatient Tower C5L-100, Los Angeles, CA 90033; email:

© 2015 Lippincott Williams & Wilkins, Inc.