Risk factors for infection and evaluation of Sepsis-3 in patients with trauma

Abstract

Background: We aim to examine the risk factors associated with infection in trauma patients and the Sepsis-3 definition.

Methods: This was a retrospective cohort study of adult trauma patients admitted to a Level I trauma center between January 2014 and January 2016.

Results: A total of 1499 trauma patients met inclusion criteria and 15% (n = 232) had an infection. Only 19.8% (n = 46) of infected patients met criteria for Sepsis-3, with the majority (43%) of infected cases having a Sequential Organ Failure Assessment (SOFA) score greater on admission compared to the time of suspected infection. In-hospital death was 7% vs 9% (p = 0.65) between Sepsis-3 and infected patients, respectively. Risk factors associated with infection were female sex, admission SOFA score, Elixhauser score, and severe injury (P < 0.05).

Conclusion: Patients with trauma often arrive with organ dysfunction, which adds complexity and inaccuracy to the operational definition of Sepsis-3 using changes in SOFA scores. Injury severity score, comorbidities, SOFA score, and sex are risk factors associated with developing an infection after trauma.

Keywords: SOFA score; Sepsis; Sepsis-3; Suspected infection; Trauma.