Abstract
Background
Ventilator-associated pneumonia (VAP) is a common intensive care unit (ICU) infection linked to increased morbidity and mortality. Trauma patients may be at a higher risk for VAP due to factors like chest wall injury, pulmonary contusions, and aspiration risk. Limited data exists on this population despite VAP being a quality metric reported to the Trauma Quality Improvement Program (TQIP). We hypothesized that reported VAP rates will be lower than clinically significant infections.
Methods
This retrospective study analyzed intubated adult trauma patients at a single Level 1 trauma center between January 2019 and December 2023. VAP was defined as at least moderate growth of a speciated organism on respiratory culture obtained 2 or more days after intubation. The primary aim of this study is to compare trauma registry reported VAP rates with clinically significant respiratory infection.
Results
Over 5 years, 980 patients had a median age of 42 years, sustaining blunt injuries (71.3%) with a median injury severity score of 20. While the trauma registry reported VAP in 8.3% of patients, clinical VAP was identified in 23.7%. When comparing the trauma registry ability to predict the presence of clinically significant respiratory infection, VAP predicted clinically significant respiratory infection with only 29.2% sensitivity, with an area under the receiver operating characteristic curve of 0.640.
Conclusions
VAP is underreported in trauma registries. Improved definitions, reporting standards, and diagnostic use of respiratory cultures are essential to enhance the reliability and utility of VAP as a quality metric and study tool in trauma patients.
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