{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T04:36:10Z","timestamp":1780461370444,"version":"3.54.1"},"reference-count":27,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,2,4]],"date-time":"2020-02-04T00:00:00Z","timestamp":1580774400000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2020,1,18]]},"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The recent decrease in multiple organ dysfunction syndrome (MODS)-associated and adult respiratory distress syndrome (ARDS)-associated mortality could be considered a success of improvements in trauma care. However, the incidence of infections remains high in patients with polytrauma, with high morbidity and hospital resources usage. Infectious complications might be a residual effect of the decrease in MODS-related\/ARDS-related mortality. This study investigated the current incidence of infectious complications in polytrauma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A 5.5-year prospective population-based cohort study included consecutive severely injured patients (age &gt;15) admitted to a (Level-1) trauma center intensive care unit (ICU) who survived &gt;48\u2009hours. Demographics, physiologic and resuscitation parameters, multiple organ failure and ARDS scores, and infectious complications (pneumonia, fracture-related infection, meningitis, infections related to blood, wound, and urinary tract) were prospectively collected. Data are presented as median (IQR), p&lt;0.05 was considered significant.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>297 patients (216 (73%) men) were included with median age of 46 (27\u201360) years, median Injury Severity Score was 29 (22\u201335), 96% sustained blunt injuries. 44 patients (15%) died. One patient (2%) died of MODS and 1 died of ARDS. 134 patients (45%) developed 201 infectious complications. Pneumonia was the most common complication (50%). There was no difference in physiologic parameters on arrival in emergency department and ICU between patients with and without infectious complications. Patients who later developed infections underwent more often a laparotomy (32% vs 18%, p=0.009), had more often pelvic fractures (38% vs 25%,p=0.02), and received more blood products &lt;8\u2009hours. They had more often MODS (25% vs 13%, p=0.005), stayed longer on the ventilator (10 (5\u201315) vs 5 (2\u20138) days, p&lt;0.001), longer in ICU (11 (6\u201317) vs 6 (3\u201310) days, p&lt;0.001), and in hospital (30 (20\u201344) vs 16 (10\u201324) days, p&lt;0.001). There was however no difference in mortality (12% vs 17%, p=0.41) between both groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>45% of patients developed infectious complications. These patients had similar mortality rates, but used more hospital resources. With low MODS-related and ARDS-related mortality, infections might be a residual effect, and are one of the remaining challenges in the treatment of patients with polytrauma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>Level 3.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Study type<\/jats:title>\n                  <jats:p>Population-based cohort study.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2019-000398","type":"journal-article","created":{"date-parts":[[2020,2,5]],"date-time":"2020-02-05T04:36:24Z","timestamp":1580877384000},"page":"e000398","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Attenuation of MODS-related and ARDS-related mortality makes infectious complications a remaining challenge in the severely injured"],"prefix":"10.1136","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1166-0990","authenticated-orcid":false,"given":"Karlijn J.P.","family":"van Wessem","sequence":"first","affiliation":[{"name":"Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Falco","family":"Hietbrink","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke P.H.","family":"Leenen","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,2,4]]},"reference":[{"key":"2025082410301214000_5.1.e000398.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2005.05.003"},{"key":"2025082410301214000_5.1.e000398.2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00068-011-0168-4","article-title":"Epidemiology of in-hospital trauma deaths","volume":"38","author":"Lefering","year":"2012","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2025082410301214000_5.1.e000398.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-009-0266-1"},{"key":"2025082410301214000_5.1.e000398.4","doi-asserted-by":"crossref","DOI":"10.1186\/s13017-019-0244-3","article-title":"Neutrophil heterogeneity and its role in infectious complications after severe trauma","volume":"14","author":"Hesselink","year":"2019","journal-title":"World J Emerg Surg"},{"key":"2025082410301214000_5.1.e000398.5","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2018-000232","article-title":"Incidence of acute respiratory distress syndrome and associated mortality in a polytrauma population","volume":"3","author":"van Wessem","year":"2018","journal-title":"Trauma Surg Acute Care Open"},{"key":"2025082410301214000_5.1.e000398.6","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/SHK.0000000000000938","article-title":"Reduction in mortality rates of Postinjury multiple organ dysfunction syndrome: a shifting paradigm? A prospective population-based cohort study","volume":"49","author":"van Wessem","year":"2018","journal-title":"Shock"},{"key":"2025082410301214000_5.1.e000398.7","doi-asserted-by":"crossref","first-page":"2677","DOI":"10.1007\/s00268-015-3162-x","article-title":"Demographic patterns and outcomes of patients in level I trauma centers in three international trauma systems","volume":"39","author":"Gunning","year":"2015","journal-title":"World J Surg"},{"key":"2025082410301214000_5.1.e000398.8","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1097\/TA.0b013e31827a6e69","article-title":"Changes in the epidemiology and prediction of multiple-organ failure after injury","volume":"74","author":"Dewar","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410301214000_5.1.e000398.9","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1097\/TA.0000000000000406","article-title":"Comparison of postinjury multiple-organ failure scoring systems: Denver versus sequential organ failure assessment","volume":"77","author":"Dewar","year":"2014","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410301214000_5.1.e000398.10","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1994.01420250051006"},{"key":"2025082410301214000_5.1.e000398.11","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.5669"},{"key":"2025082410301214000_5.1.e000398.12","doi-asserted-by":"crossref","DOI":"10.1186\/s13049-016-0321-5","article-title":"Which score should be used for posttraumatic multiple organ failure? - Comparison of the MODS, Denver- and SOFA- Scores","volume":"24","author":"Fr\u00f6hlich","year":"2016","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"2025082410301214000_5.1.e000398.13","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1097\/TA.0000000000001328","article-title":"Defining multiple organ failure after major trauma: a comparison of the Denver, sequential organ failure assessment, and Marshall scoring systems","volume":"82","author":"Hutchings","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410301214000_5.1.e000398.14","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.7247"},{"key":"2025082410301214000_5.1.e000398.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2008.03.002"},{"key":"2025082410301214000_5.1.e000398.16","first-page":"23","article-title":"Guide for the prevention of surgical site infection","volume":"85","year":"2000","journal-title":"Bull Am Coll Surg"},{"key":"2025082410301214000_5.1.e000398.17","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1097\/TA.0b013e31829fdbd7","article-title":"The burden of infection in severely injured trauma patients and the relationship with admission shock severity","volume":"76","author":"Cole","year":"2014","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410301214000_5.1.e000398.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2017.08.040"},{"key":"2025082410301214000_5.1.e000398.19","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000050454.01978.3B"},{"key":"2025082410301214000_5.1.e000398.20","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318206d3df"},{"key":"2025082410301214000_5.1.e000398.21","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2011.41"},{"key":"2025082410301214000_5.1.e000398.22","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1001\/archsurg.134.11.1222","article-title":"Differences between bacterial species shown by simultaneous assessment of neutrophil phagocytosis and generation of reactive oxygen intermediates in trauma patients","volume":"134","author":"Taylor","year":"1999","journal-title":"Arch Surg"},{"key":"2025082410301214000_5.1.e000398.23","doi-asserted-by":"crossref","DOI":"10.3389\/fcimb.2017.00160","article-title":"With friends like these: the complex role of neutrophils in the progression of severe pneumonia","volume":"7","author":"Pechous","year":"2017","journal-title":"Front Cell Infect Microbiol"},{"key":"2025082410301214000_5.1.e000398.24","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1177\/000313480907500408","article-title":"Transfusion, not just injury severity, leads to posttrauma infection: a matched cohort study","volume":"75","author":"Sadjadi","year":"2009","journal-title":"Am Surg"},{"key":"2025082410301214000_5.1.e000398.25","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-008-9655-0"},{"key":"2025082410301214000_5.1.e000398.26","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14409-1"},{"key":"2025082410301214000_5.1.e000398.27","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/s13054-019-2480-z","article-title":"The ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre study","volume":"23","author":"Buitinck","year":"2019","journal-title":"Crit Care"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2019-000398","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T17:30:27Z","timestamp":1756056627000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2019-000398"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,2,4]]},"published-print":{"date-parts":[[2020,2]]}},"alternative-id":["10.1136\/tsaco-2019-000398"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2019-000398","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2]]}}}