Anales de la Facultad de Ciencias Médicas (Asunción)
versión impresa ISSN 1816-8949
GOIBURU, ME et al. The impact of malnutrition on morbidity, mortality and length of hospital stay in trauma patients. An. Fac. Cienc. Méd. (Asunción) [online]. 2005, vol.38, n.4, pp. 51-89. ISSN 1816-8949.
Abstract-Background & aim: A rapid development of malnutrition associated with organ dysfunction and nosocomial infections has been described in severe trauma victims. The aim of this study was to evaluate the nutritional status of patients admitted to a National Trauma Reference Center and evaluate its relationship with clinical evolution. Methods: This was a prospective study evaluating adult patients admitted to the Intensive Care, General Surgery, Maxillofacial Surgery and Orthopedics departments of the Medical Emergencies Center in Asuncion, Paraguay. Patients were taken consecutively from March 2002 to March 2004. The prevalence of malnutrition was determined using the Subjective Global Assessment (SGA). We also determined the lymphocyte count (linphopenia < 1500 cel/mm3) albumina levels (hypoalbuminemia < 3.4 g/dl). Patients were followed to determine length of hospital stay, complications and in-hospital mortality. The risk factors analyzed were: nutritional parameters (hypoalbuminemia, lymphopenia, SGA), age, sex, surgical intervention, anemia and injury severity score (ISS). Data were processed using EPIINFO 2002. The SPSS was used for multivariate analysis. For group comparisons p<0.05 was considered significant, and results were reported as relative risk (RR) with a 95% confidence interval. Results: A total of 161 patients were evaluated, with a median of 27 (14-92) years of age. There were 94% males and 6% females. Most (74%) were from the countryside and 26% were from the capital city. The most frequent anatomic sites of trauma were: head injuries 25%, thoracic trauma 16.6%, limb trauma 15.4%, abdominal trauma 14%. The median Injury Severity Score (ISS) was 20 (1-39). Nearly half (40%) of patients were malnourished or at risk of malnutrition according to the SGA, 45% were lymphopenic and 34% had hypoalbuminemia. Multivariate analysis identified the following 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); risk factors for length of stay were malnutrition according to the SGA p=0.01, RR=2.3 (1.2-4.7) and ISS over 20, p=0.03, RR=2.8 (1-7.3). Conclusions: Malnutrition is frequent on admission in trauma patients, and must be diagnosed quickly because it is an independent risk factor for morbidity and mortality, and prolongs the length of hospitalization.