The impact of malnutrition on morbidity, mortality and length of hospital stay in trauma patients
GOIBURU ME, JURE GOIBURU MM, BIANCO H, RUIZ DÍAZ J, ALDERETE F, PALACIOS MC, CABRAL V, ESCOBAR D, LÓPEZ R, WAITZBERG DL
Nutrición Hospitalaria 2006;21(5): 604-610
Resumen del Autor:
Background & aim: To asses the nutritional status of
hospitalised trauma patients and the repercussion on the
clinical follow up.
Methods: In a prospective way 161 adult patients admitted
to the units of Intensive Care (ICU), General Surgery,
Maxillofacial Surgery and Orthopedics of the Centro
de Emergencias Médicas in Asunción, Paraguay,
from March 2002 to March 2004 were evaluated at admission
by using the Subjective Global Assessment
(SGA). Patients were followed to determine length of
hospital stay, complications and in-hospital mortality.
Results: From the trauma patients median age was 27
(14-92) years and 94% were males. Most patients (74%)
were from the countryside. The most frequent anatomic
sites of trauma were: head 25%, thorax 16.6%, limbs
15.4%, abdomen 14%. The median Injury Severity Score
(ISS) was 20 (1-39). From this population of patients,
40% were malnourished or at risk of malnutrition according
to the SGA. Multivariate analysis identified as
significant risk factors for mortality: malnutrition according
to the SGA (p = 0.04, RR = 4 (1-15), and admission
to the ICU (p = 0.0001, RR 53 (12-234). Risk factors
for complications were malnutrition according to the
SGA (p = 0.003, RR 2.9 (1.4-5.8) and ISS over 20 (p =
0.001, RR = 8.4 (2.3-29.9). The risk factors for length of
stay were malnutrition according to the Subjective Global
Assesment (p = 0.01, RR = 2.3 (1.2-4.7) and Injury
Severity Score over 20, p = 0.03, RR = 2.8 (1-7.3).
Conclusions: In the conditions of this study, malnutrition
is frequent on admission in trauma patients, and is
an independent risk factor for morbidity, mortality, and prolongs the length of hospitalisation. Efforts should be
made to quickly assess the nutritional status of these patients
and early start nutritional intervention.
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