Citation

Wafaisade A, Lefering R, Bouillon B, Sakka SG, Thamm OC, Paffrath T, Neugebauer E, Maegele M. Crit. Care Med. 2011; 39(4): 621-628.

Affiliation

Departments of Trauma and Orthopedic Surgery (AW, BB, TP, MM) and Anesthesiology and Intensive Care Medicine (SGS) and Institute for Research in Operative Medicine (AW, RL, OCT, EN, MM), University of Witten/Herdecke, Cologne-Merheim Medical Center, Cologne; and Committee on Emergency Medicine, Intensive and Trauma Care (Sektion NIS), German Society for Trauma Surgery, Berlin, Germany.

Copyright

(Copyright © 2011, Society of Critical Care Medicine, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/CCM.0b013e318206d3df

PMID

21242798

Abstract

OBJECTIVES:: The objectives of this study were 1) to assess potential changes in the incidence and outcome of sepsis after multiple trauma in Germany between 1993 and 2008 and 2) to evaluate independent risk factors for posttraumatic sepsis. DESIGN:: Retrospective analysis of a nationwide, population-based prospective database, the Trauma Registry of the German Society for Trauma Surgery. SETTING:: A total of 166 voluntarily participating trauma centers (levels I-III). PATIENTS:: Patients registered in the Trauma Registry of the German Society for Trauma Surgery between 1993 and 2008 with complete data sets who presented with a relevant trauma load (Injury Severity Score of ≥9) and were admitted to an intensive care unit (n = 29,829). INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Over the 16-yr study period, 10.2% (3,042 of 29,829) of multiply injured patients developed sepsis during their hospital course. Annual data were summarized into four subperiods: 1993-1996, 1997-2000, 2001-2004, and 2005-2008. The incidences of sepsis for the four subperiods were 14.8%, 12.5%, 9.4%, and 9.7% (p < .0001), respectively. In-hospital mortality for all trauma patients decreased for the respective subperiods (16.9%, 16.0%, 13.7%, and 11.9%; p < .0001). For the subgroup of patients with sepsis, the mortality rates were 16.2%, 21.5%, 22.0%, and 18.2% (p = .054), respectively. The following independent risk factors for posttraumatic sepsis were calculated from a multivariate logistic regression analysis: male gender, age, preexisting medical condition, Glasgow Coma Scale score of ≤8 at scene, Injury Severity Score, Abbreviated Injury ScaleTHORAX score of ≥3, number of injuries, number of red blood cell units transfused, number of operative procedures, and laparotomy. CONCLUSIONS:: The incidence of sepsis decreased significantly over the study period; however, in this decade the incidence remained unchanged. Although overall mortality from multiple trauma has declined significantly since 1993, there has been no significant decrease of mortality in the subgroup of septic trauma patients. Thus, sepsis has remained a challenging complication after trauma during the past 2 decades. Recognition of the identified risk factors may guide early diagnostic workup and help to reduce septic complications after multiple trauma.

Language: en