Predicting nosocomial bloodstream infections using surrogate markers of injury severity: clinical and methodological perspectives.

Abstract:

BACKGROUND:Injury severity indices are numerical scores that are utilized to predict nosocomial bloodstream infections (BSI) in critically ill patients. However, surrogate markers of injury severity (SMIS) may be more clinically meaningful than these commonly used numerical injury severity indices with respect to the control and prevention of nosocomial BSI. OBJECTIVE:The purpose of this study was to demonstrate the clinical and research implications of using the SMIS in predicting nosocomial BSI. METHOD:A prospective nonexperimental cohort study was conducted on 361 critically ill trauma patients. Three logistic regression models were examined for their clinical relevance and statistical parsimony. The first model included the Injury Severity Score (ISS) and 5 other independent predictors, and excluded the SMIS. The second model included all study variables. The third model excluded the ISS. RESULTS:The analysis suggested that number of blood units transfused, number of central venous catheters inserted, and use of chest tube(s) were the SMIS. The ISS was found to be an independent predictor of nosocomial BSI only when the SMIS were not included in the model. The model that included the SMIS and excluded the ISS explained the highest variance in nosocomial BSI and had the best negative predictive value (93%). DISCUSSION:Clinicians can use knowledge of SMIS to develop interventions that minimize the risk of nosocomial BSI. Hence, the SMIS can serve not only as a prediction tool but also as a way to enhance control and prevention strategies for BSI.

journal_name

Nurs Res

journal_title

Nursing research

authors

El-Masri MM,Hammad TA,Fox-Wasylyshyn SM

doi

10.1097/00006199-200507000-00010

keywords:

subject

Has Abstract

pub_date

2005-07-01 00:00:00

pages

273-9

issue

4

eissn

0029-6562

issn

1538-9847

pii

00006199-200507000-00010

journal_volume

54

pub_type

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