PURPOSE: Trauma is a major health concern. Length of hospital stay (LOS) has been targeted as an important metric to assess trauma care. This study aims to evaluate the risk factors that affect LOS among trauma patients in a trauma center in Southwestern Iran. METHODS: This cross-sectional study was conducted on patients admitted to Rajaee Trauma Center, Shiraz, Iran between January 1, 2018 and December 30, 2018. The inclusion criteria were age above 15 years and having traffic accident injuries, including car, motorcycle and pedestrian injury mechanisms. The exclusion criteria were existing diseases including cardiovascular, cerebral, renal, and pulmonary diseases prior to this study, dead upon arrival or within 48 h after admission, and stay at the hospital for less than 6 h. The risk variables analyzed for prolonged LOS were age, gender, mechanism of traffic accident injury, infection during hospital stay, type of injury, injury severity score, surgery during hospitalization, and survival. Poisson regression was performed to evaluate the partial effects of each covariate on trauma hospitalization (≥3 days as longer stay). RESULTS: This study was conducted on 14,054 patients with traffic accident injury and the mean age was (33.89 ± 15.78) years. Additionally, 74.35% of the patients were male, with male to female ratio of 2.90. The result of Poisson regression indicated that male patients, higher age, combination of thoracic injuries, onset of infected sites, and surgery patients were more susceptible to have a longer LOS. Considering the site of injury, patients with face injuries followed by those with thorax injuries had the highest means of LOS (3.74 days and 3.36 days, respectively). Simultaneous existence of surgical intervention and infection in a patient had the greatest impact on prolonged LOS. CONCLUSION This study identified that age, gender, mechanism of injury, infection, type of injury, survival, and ISS could lead to prolongation of LOS, but the affect can be reduced by eliminating modifiable risk factors.
Accidental Injuries ; Accidents, Traffic ; Adult ; Age Factors ; Facial Injuries ; Female ; Humans ; Iran ; Length of Stay ; statistics & numerical data ; Male ; Middle Aged ; Risk Factors ; Sex Factors ; Thoracic Injuries ; Wound Infection ; Young Adult

PURPOSETrauma-related injuries are the leading cause of death worldwide. Some risk factors make traumatic patients susceptible to infection. Furthermore, some mortality risk factors, including length of hospitalization and increasing age, were detected in non-traumatic infected patients. This study aimed to assess mortality risk factors among nosocomial infected traumatic patients in Rajaee trauma center, Shiraz, Iran.

METHODSThis prospective cohort study was conducted during a period of 2 years since April 2015 to March 2017 in Rajaee hospital, which is the center of emergency medical services for traumatic injuries in Shiraz, Iran. Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance system criteria were applied to define 5 types of nosocomial infections. The variables analyzed as the risk factors of infection and mortality included sex, age, mechanism of injury, site of injury, injury severity score (ISS), surgical intervention, length of hospitalization, intensive care unit (ICU) admission, and type of pathogen. Then, the incidence of nosocomial infection and also risk factors of mortality in traumatic patients were evaluated. All data analyses were performed using the statistical package for social sciences, version 15 (SPSS Inc., Chicago) and p ≤ 0.05 is considered to be statistically significant.

RESULTSThe incidence of nosocomial infection was 7.2% (p < 0.001). Pneumonia was the most common type of infection detected in our study. Infection led to a 7.8-fold increase in mortality of the traumatic patients (p < 0.001). Admission in intensive care units and old age were the main risk factors of mortality in infected traumatic patients. Old age, gunshot and motor vehicle accidents, trauma to extremities and abdomen, higher injury severity score, and prolonged hospitalization, made the traumatic patients more susceptible to infection.

CONCLUSIONThe really high incidence of nosocomial infection in traumatic patients in Iran depends on some risk factors that should be considered. Also infection increases the mortality rate in the traumatic patients, which could be reduced by eliminating its risk factors.