Predicting and preventing infection after abdominal vascular injuries.

Of 210 patients with major intra-abdominal vascular injuries, 111 (53%) survived more than 48 hours. Of these, 41 (37%) developed serious infections resulting in death or a hospital stay exceeding 14 days (mean, 55 +/- 49) in the 33 who survived. The most frequent serious infections were intraperitoneal and resulted in a 35% mortality rate (8/23). The 111 patients surviving 48+ hours were divided into two groups based on their initial E.D. BP and injuries. The "high-risk" patients (with no obtainable blood pressure on admission, five or more injuries or a colon injury with a systolic BP of 40 to 89 mm Hg) had a serious infection rate of 63% (25/40). This was significantly higher than the serious infection rate of 23% (16/71) in the remaining 71 "low-risk" patients (p less than 0.001). The patients were then evaluated for factors which surgeons might control. In the high-risk group, resuscitation adequate to produce an initial operating room (O.R.) systolic BP greater than 70 mm Hg and early control of bleeding so that less than 10 units of blood were used resulted in a serious infection rate of only 20% (2/10) versus 77% (23/30) in the other high-risk patients (p less than 0.01). In the low-risk patients, having an initial O.R. systolic BP greater than 70 mm Hg and using less than 10 units of blood resulted in a serious infection rate of 13% (6/48) versus 43% (10/23) in the others (p less than 0.05). High-risk patients failing to meet these resuscitation goals must be watched particularly carefully for development of infections.