PMID- 30531329
OWN - NLM
STAT- MEDLINE
DCOM- 20200525
LR  - 20240328
IS  - 2163-0763 (Electronic)
IS  - 2163-0755 (Print)
IS  - 2163-0755 (Linking)
VI  - 86
IP  - 2
DP  - 2019 Feb
TI  - Accurate risk stratification for development of organ/space surgical site 
      infections after emergent trauma laparotomy.
PG  - 226-231
LID - 10.1097/TA.0000000000002143 [doi]
AB  - BACKGROUND: Organ/space surgical site infection (OS-SSI) develops frequently 
      after trauma laparotomies and is associated with significant morbidity. No valid 
      model exists to accurately risk-stratify the probability of OS-SSI development 
      after emergent laparotomy. Risk stratification for OS-SSI in these patients could 
      guide promising, but unproven, interventions for OS-SSI prevention, such as more 
      frequent dosing of intraoperative antibiotics or direct peritoneal resuscitation. 
      We hypothesize that in trauma patients who undergo emergent laparotomy, 
      probability of OS-SSI can be accurately estimated using patient data available 
      during the index operation. METHODS: Retrospective review was performed on a 
      prospectively maintained database of emergent trauma laparotomies from 2011 to 
      2016. Patient demographics and risk factors for OS-SSI were collected. We 
      performed Bayesian multilevel logistic regression to develop the model based on a 
      70% training sample. Evaluation of model fit using area under the curve was 
      performed on a 30% test sample. The Bayesian approach allowed the model to 
      address clustering of patients within physician while implementing regularization 
      to improve predictive performance on test data. RESULTS: One hundred seventy-two 
      (15%) of 1,171 patients who underwent laparotomy developed OS-SSI. Variables 
      thought to affect development of surgical site infections and were available to 
      the surgeon near the conclusion of the trauma laparotomy were included in the 
      model. Two variables that contributed most to OS-SSIs were damage-control 
      laparotomy and colon resection. The area under the curve of the predictive model 
      validated on the test sample was 0.78 (95% confidence interval, 0.71-0.85). 
      CONCLUSION: Using a combination of factors available to surgeons before the end 
      of an emergent laparotomy, the probability of OS-SSI could be accurately 
      estimated using this retrospective cohort. A Web-based calculator is under design 
      to allow the real-time estimation of probability of OS-SSI intraoperatively. 
      Prospective validation of its generalizability to other trauma cohorts and of its 
      utility at the point of care is required. LEVEL OF EVIDENCE: Prognostic study, 
      level IV.
FAU - Wei, Shuyan
AU  - Wei S
AD  - From the Center for Translational Injury Research (S.W., L.S.K., C.E.W., J.A.H.), 
      Department of Surgery (S.W., L.S.K., C.E.W., J.A.H.), Department of Pediatrics 
      (C.G., V.T.T.), Center for Surgical Trials and Evidence-based Practice (L.S.K.), 
      and Center for Clinical Research and Evidence-based Medicine (V.T.T.), McGovern 
      Medical School at the University of Texas Health Science Center, Houston, Texas.
FAU - Green, Charles
AU  - Green C
FAU - Kao, Lillian S
AU  - Kao LS
FAU - Padilla-Jones, Brandy B
AU  - Padilla-Jones BB
FAU - Truong, Van Thi Thanh
AU  - Truong VTT
FAU - Wade, Charles E
AU  - Wade CE
FAU - Harvin, John A
AU  - Harvin JA
LA  - eng
GR  - KL2 TR000370/TR/NCATS NIH HHS/United States
GR  - T32 GM008792/GM/NIGMS NIH HHS/United States
GR  - UL1 TR000371/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - J Trauma Acute Care Surg
JT  - The journal of trauma and acute care surgery
JID - 101570622
SB  - IM
MH  - Adult
MH  - Bayes Theorem
MH  - Emergency Medical Services/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Laparotomy/*adverse effects
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Risk Factors
MH  - Surgical Wound Infection/*etiology
MH  - Young Adult
PMC - PMC7004798
MID - NIHMS1052794
COIS- The authors have no conflicts of interest.
EDAT- 2018/12/12 06:00
MHDA- 2020/05/26 06:00
PMCR- 2020/02/06
CRDT- 2018/12/12 06:00
PHST- 2018/12/12 06:00 [pubmed]
PHST- 2020/05/26 06:00 [medline]
PHST- 2018/12/12 06:00 [entrez]
PHST- 2020/02/06 00:00 [pmc-release]
AID - 10.1097/TA.0000000000002143 [doi]
PST - ppublish
SO  - J Trauma Acute Care Surg. 2019 Feb;86(2):226-231. doi: 
      10.1097/TA.0000000000002143.