TY - JOUR
T1 - Late outcomes of trauma patients with infections during index hospitalization
AU - Czaja, Angela S.
AU - Rivara, Frederick P.
AU - Wang, Jin
AU - Koepsell, Thomas
AU - Nathens, Avery B.
AU - Jurkovich, Gregory J.
AU - MacKenzie, Ellen
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2009/10
Y1 - 2009/10
N2 - 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. coypright
AB - 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. coypright
KW - Functional status
KW - Infection
KW - Outcomes
KW - Trauma
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U2 - 10.1097/TA.0b013e318185e1fb
DO - 10.1097/TA.0b013e318185e1fb
M3 - Article
C2 - 19820589
AN - SCOPUS:72449208093
SN - 0022-5282
VL - 67
SP - 805
EP - 814
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 4
ER -