Document Detail


Ventilator-associated pneumonia rates at major trauma centers compared with a national benchmark: a multi-institutional study of the AAST.
MedLine Citation:
PMID:  22673241     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Ventilator-associated pneumonia (VAP) rates reported by the National Healthcare Safety Network (NHSN) are used as a benchmark and quality measure, yet different rates are reported from many trauma centers. This multi-institutional study was undertaken to elucidate VAP rates at major trauma centers.
METHODS: VAP rate/1,000 ventilator days, diagnostic methods, institutional, and aggregate patient data were collected retrospectively from a convenience sample of trauma centers for 2008 and 2009 and analyzed with descriptive statistics.
RESULTS: At 47 participating Level I and II centers, the pooled mean VAP rate was 17.2 versus 8.1 for NHSN (2006-2008). Hospitals' rates were highly variable (range, 1.8-57.6), with 72.3% being above NHSN's mean. Rates differed based on who determined the rate (trauma service, 27.5; infection control or quality or epidemiology, 11.9; or collaborative effort, 19.9) and the frequency with which VAP was excluded based on aspiration or diagnosis before hospital day 5. In 2008 and 2009, blunt trauma patients had higher VAP rates (17.3 and 17.6, respectively) than penetrating patients (11.0 and 10.9, respectively). More centers used a clinical diagnostic strategy (57%) than a bacteriologic strategy (43%). Patients with VAP had a mean Injury Severity Score of 28.7, mean Intensive Care Unit length of stay of 20.8 days, and a 12.2% mortality rate. 50.5% of VAP patients had a traumatic brain injury.
CONCLUSIONS: VAP rates at major trauma centers are markedly higher than those reported by NHSN and vary significantly among centers. Available data are insufficient to set benchmarks, because it is questionable whether any one data set is truly representative of most trauma centers. Application of a single benchmark to all centers may be inappropriate, and reliable diagnostic and reporting standards are needed. Prospective analysis of a larger data set is warranted, with attention to injury severity, risk factors specific to trauma patients, diagnostic method used, VAP definitions and exclusions, and reporting guidelines.
LEVEL OF EVIDENCE: III, prognostic study.
Authors:
Christopher P Michetti; Samir M Fakhry; Pamela L Ferguson; Alan Cook; Forrest O Moore; Ronald Gross;
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  72     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-06-07     Completed Date:  2012-08-21     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1165-73     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Inova Regional Trauma Center, Falls Church, Virginia 22042, USA. christopher.michetti@inova.org
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MeSH Terms
Descriptor/Qualifier:
Benchmarking*
Female
Humans
Incidence
Intensive Care Units
Length of Stay / trends
Male
Middle Aged
Pneumonia, Ventilator-Associated / epidemiology*,  etiology
Prognosis
Quality Assurance, Health Care*
Retrospective Studies
Risk Factors
Trauma Centers*
United States / epidemiology
Ventilators, Mechanical / adverse effects
Investigator
Investigator/Affiliation:
Raul Coimbra / ; Jay J Doucet / ; Christine S Cocanour / ; Linda Cooke / ; Heather L Evans / ; Joseph Cuschieri / ; Margarita Bass / ; Peep Talving / ; Louis H Alarcon / ; Andrew B Peitzman / ; Christopher J Dente / ; Bryan C Morse / ; Therese M Duane / ; Jinfeng Han / ; Tammy R Kopelman / ; Starre Haney / ; Rosemary A Kozar / ; Bryan A Cotton / ; Dustin L Smoot / ; Donald H Jenkins / ; Bruce J Simon / ; Nam Heui Kim / ; Samir M Fakhry / ; Pamela L Ferguson / ; Christopher P Michetti / ; Tayseer Aldaghlas / ; Forrest O Moore / ; Pamela W Goslar / ; Scott H Norwood / ; Alan D Cook / ; Ronald I Gross / ; John C Lee / ; Jo Ann Miller / ; Kimberly A Davis / ; Adrian A Maung / ; Daryhl Johnson / ; Christian T Minshall / ; Riad Cachecho / ; Margie Finocchiaro / ; Robert J Winchell / ; Preston R Miller / ; Andre R Campbell / ; Mary Nelson / ; Cassandra Sappington / ; Gerald J Fulda / ; Marci L Drees / ; Marie L Crandall / ; Michael D Grossman / ; Wendy L Wahl / ; Andrew C Bernard / ; Phillip K Chang / ; Christopher M Watson / ; Raymond P Bynoe / ; Patrick K Kim / ; Joseph V Sakran / ; H Gill Cryer / ; Sigrid Burruss / ; Eric J Ferguson / ; Michael F Oswanski / ; Adrian W Ong / ; Quyen Tran / ; Randolph E Szlabick / ; Vicky Black / ; Ziad C Sifri / ; Anastasia Kunac / ; William Shillinglaw / ; Kellie Moore / ; Charles Kung Chao Hu / ; Vicki J Bennett / ; Victor J Sorensen / ; Shumaila Syed / ; Daniel Carney / ; Keith Clancy / ; David J Dries / ; Michael D McGonigal / ; Loubna Salameh / ; Brett Hartman / ; John B Fortune / ; Wes McMillian / ; Alan H Tyroch / ; Susan F McLean / ; Javier A Romero / ; Graal Diaz / ; Christopher R Kaufmann / ; Stephanie N Vanburen / ; R Jospeh Nold / ; James M Haan / ; Michael L Foreman / ; Alan Cook / ; Barbara A Latenser / ; Dionne Skeete /

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