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Injury Pattern and Risk of Hospital-Acquired Pneumonia Among Pediatric Trauma Patients
Gretchen J. Cutler, PhD, MPH, Anupam B. Kharbanda, MD, MSc, and Henry W. Ortega, MD, Children's Hospitals and Clinics of Minnesota, Minneapolis MN

Abstract:
Background: There is a lack of research regarding the development of hospital acquired pneumonia (HAP) in pediatric populations. Specifically, little is known regarding the relationship between injury pattern and risk of HAP in youth. Methods: Analyses included patients less than 19 years of age treated at trauma centers contributing to the National Trauma Data Bank between 2009-2011 who had a length of stay of 2 days or longer. Multivariable logistic regression was used to examine the association between injury region and odds of developing HAP adjusting for age group, gender, injury severity, days of mechanical ventilation, length of stay, days in the ICU, and number of comorbid conditions. Results: A total of 106,748 patients were eligible for analysis, and 1,449 patients developed pneumonia. In adjusted regression models, pediatric patients with isolated injuries of the extremities or isolated torso injuries had significantly reduced odds of developing HAP compared to patients with head and neck injuries (OR=0.32, 95% CI: 0.22-0.48; OR=0.63, 95% CI: 0.46-0.86, respectively). Patients with isolated injuries of the spine and back or those with multi-site injuries did not have significantly different odds of developing HAP compared to patients with head and neck injuries (OR=0.97, 95% CI: 0.60-1.60; OR=0.98, 95% CI: 0.85-1.14, respectively). Conclusion: Pediatric trauma patients with isolated injuries of the extremities or torso had a reduced risk of developing HAP compared to patients with head and neck injuries. Information on risk of HAP by injury pattern can be used to risk stratify who gets HAP prophylaxis.
Objective:
At the end of this activity, the learner will be able to identify subgroups of pediatric trauma patients who should be treated early and aggressively to help prevent the development of hospital acquired pneumonia (HAP).
Objective Content: At the end of this activity, the learner will be able to explain that pediatric trauma patients with isolated injuries to the head and neck have a higher risk of developing hospital acquired pneumonia (HAP) compared to patients with isolated extremity or torso injuries. They will also be able to explain that odds of developing HAP are similar in pediatric trauma patients with isolated injuries to the head and neck or the spine and back, and in patients with multi-site injuries, and that these subgroups of trauma patients should be treated early and aggressively to avoid development of HAP.


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