Epidemiology and risk factors of sepsis after multiple trauma: An analysis of 29,829 patients from the Trauma Registry of the German Society for Trauma Surgery

• Published in: Critical care medicine Vol. 39; no. 4; pp. 621 - 628
• Main Authors: Wafaisade, Arasch, Lefering, Rolf, Bouillon, Bertil, Sakka, Samir G, Thamm, Oliver C, Paffrath, Thomas, Neugebauer, Edmund, Maegele, Marc
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD by the Society of Critical Care Medicine and Lippincott Williams & Wilkins 01-04-2011; Lippincott Williams & Wilkins
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine; Female; Germany - epidemiology; Glasgow Coma Scale; Humans; Incidence; Injury Severity Score; Intensive care medicine; Logistic Models; Male; Medical sciences; Middle Aged; Multiple Trauma - complications; Multiple Trauma - epidemiology; Multiple Trauma - mortality; Multivariate Analysis; Registries; Retrospective Studies; Risk Factors; Sepsis - epidemiology; Sepsis - etiology; Sepsis - mortality; Trauma Centers - statistics & numerical data; Germany; Human; Intensive care; risk factors; Prognosis; Mortality; Epidemiology; Trauma; multivariate analysis; Incidence; Infection; Sepsis syndrome; Surgery; Risk factor; multiple trauma; Multiple injury; Resuscitation; outcome; sepsis
• ISSN: 0090-3493; 1530-0293
• DOI: 10.1097/CCM.0b013e318206d3df

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 subperiods1993–1996, 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 analysismale 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.