Efstathios Karamanos1, Arielle Hodari Gupta2, Cletus Nor Stanton3, Adhnan Mohamed4, Joe H Patton5, Nathan Schmoekel6. 1. Surgeon in the Division of Acute Care Surgery in the Department of Surgery at Henry Ford Hospital in Detroit, MI (ekarama1@hfhs.org). 2. Surgeon at Henry Ford Hospital in Detroit, MI (agupta12@hfhs.org). 3. Surgeon at Henry Ford Hospital in Detroit, MI (cstanto1@hfhs.org). 4. Surgeon at Henry Ford Hospital in Detroit, MI (amohame4@hfhs.org). 5. Surgeon at Henry Ford Hospital in Detroit, MI (ppatton1@hfhs.org). 6. Surgeon at Henry Ford Hospital in Detroit, MI (nschmoe2@hfhs.org).
Abstract
CONTEXT: Clostridium difficile-associated infection (CDAI) can result in longer hospitalization, increased morbidity, and higher mortality rates for surgical patients. The impact on trauma patients is unknown, however. OBJECTIVE: To assess the effect of CDAI on trauma patients and develop a scoring system to predict CDAI in that population. METHODS: Records of all trauma patients admitted to a Level I Trauma Center from 2001 to 2014 were retrospectively reviewed. Presence of CDAI was defined as evidence of positive toxin or polymerase chain reaction. Patients with CDAI were matched to patients without CDAI using propensity score matching on a ratio of 1:3. MAIN OUTCOME MEASURES: Primary outcome was inhospital mortality. Secondary outcomes included length of stay and need for mechanical ventilation. A decision-tree analysis was performed to develop a predicting model for CDAI in the study population. RESULTS: During the study period, 11,016 patients were identified. Of these, 50 patients with CDAI were matched to 150 patients without CDAI. There were no differences in admission characteristics and demographics. Patients in whom CDAI developed had significantly higher mortality (12% vs 4%, p < 0.01), need for mechanical ventilation (57% vs 23%, p < 0.01), and mean hospital length of stay (15.3 [standard deviation 1.4]) days vs 2.1 [0.6] days, p < 0.0). CONCLUSION: In trauma patients, CDAI results in significant morbidity and mortality. The C difficile influencing factor score is a useful tool in identifying patients at increased risk of CDAI.
CONTEXT: Clostridium difficile-associated infection (CDAI) can result in longer hospitalization, increased morbidity, and higher mortality rates for surgical patients. The impact on traumapatients is unknown, however. OBJECTIVE: To assess the effect of CDAI on traumapatients and develop a scoring system to predict CDAI in that population. METHODS: Records of all traumapatients admitted to a Level I Trauma Center from 2001 to 2014 were retrospectively reviewed. Presence of CDAI was defined as evidence of positive toxin or polymerase chain reaction. Patients with CDAI were matched to patients without CDAI using propensity score matching on a ratio of 1:3. MAIN OUTCOME MEASURES: Primary outcome was inhospital mortality. Secondary outcomes included length of stay and need for mechanical ventilation. A decision-tree analysis was performed to develop a predicting model for CDAI in the study population. RESULTS: During the study period, 11,016 patients were identified. Of these, 50 patients with CDAI were matched to 150 patients without CDAI. There were no differences in admission characteristics and demographics. Patients in whom CDAI developed had significantly higher mortality (12% vs 4%, p < 0.01), need for mechanical ventilation (57% vs 23%, p < 0.01), and mean hospital length of stay (15.3 [standard deviation 1.4]) days vs 2.1 [0.6] days, p < 0.0). CONCLUSION: In traumapatients, CDAI results in significant morbidity and mortality. The C difficile influencing factor score is a useful tool in identifying patients at increased risk of CDAI.
Authors: Demetrios Demetriades; Brian Kimbrell; Ali Salim; George Velmahos; Peter Rhee; Christy Preston; Ginger Gruzinski; Linda Chan Journal: J Am Coll Surg Date: 2005-09 Impact factor: 6.113
Authors: Demetrios Demetriades; James Murray; Kiriakos Charalambides; Kathy Alo; George Velmahos; Peter Rhee; Linda Chan Journal: J Am Coll Surg Date: 2004-01 Impact factor: 6.113
Authors: Jennifer L Kuntz; David H Smith; Amanda F Petrik; Xiuhai Yang; Micah L Thorp; Tracy Barton; Karen Barton; Matthew Labreche; Steven J Spindel; Eric S Johnson Journal: Perm J Date: 2016
Authors: Efstathios Karamanos; Hassan Ahmad; Ahmed A Makhani; Ameesh N Dev; Noah Saad; Bao-Quynh Julian; Husain AlQattan; Howard Wang; Douglas Cromack Journal: Plast Reconstr Surg Glob Open Date: 2020-11-20