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New Perspectives on Old Problems: Central Line Associated Blood Stream Infection after Initial Insertion
Vol. 223, No. 4S2, October 2016
RESULTS: Of the 385 qualifying patients, average age was 77.5 years and 51% were women. Average Injury Severity Score was 10.3 and inpatient mortality was 5.7%. Patients on the GeriTrauma service had higher rates of delirium screening (45% [35.3-55.4] vs 33% [25.2-40.2] and 20% [13.4-26.6] on GeriTrauma (n¼95), Trauma (n¼150) and Other (n¼140) respectively) and delirium diagnosis (36% [26.3-45.4] vs 14% [8.4-19.6] and 18% [11.5-24.2]) (Table 1). Geriatric consultation also increased involvement of physical therapy (95.8% [91.8-99.8] vs 71.3% [64.1-78.6] and 72.9% [65.5- 80.2]). There was no effect on length of stay. Documentation of goals of care discussions was low, and benzodiazepines were used for many patients. CONCLUSIONS: Geriatric consultation improves quality of care for trauma patients without increasing length of stay or mortality. Areas of further need include medication reconciliation and management, and goals of care documentation.
New Perspectives on Old Problems: Central Line Associated Blood Stream Infection after Initial Insertion Arielle Hodari, MD, Matthew Goodwin, Kaori Ito, MD, Nathan Schmoekel, Dionne J Blyden, MD, FACS, Jack Jordan, Ryan D Kather, Ilan S Rubinfeld, MD, FACS Henry Ford Hospital, Detroit, MI INTRODUCTION: Historically, interventions to prevent line infections were based on placement. As that is no longer true, we hypothesized there would be some duration where infection rates would rise and recommendations for replacement based on cumulative maintenance risk made. METHODS: All central lines from a single large teaching-hospital were analyzed (2014-2015). central venous catheters (CVC), PICC lines, and implanted ports were included. Line infections were labeled by infection control experts according to NHSN criterion. Data analyzed in R.
Scientific Poster Presentations: 2016 Clinical Congress
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remove lines promptly, and that ICU patients remain at highest risk for this adverse event. Noninvasive Prediction of Neuroworsening in Patints with Traumatic Brain Injury Nehu Parimi, Shiming Yang, PhD, Peter F Hu, PhD, Hsiao-Chi Li, PhDc, Ifeatu Onyekwelu, Leslie A Sult, Thomas M Scalea, MD, FACS, Deborah Stein, MD, MPH University of Maryland, Baltimore, MD INTRODUCTION: Management of trauma brain injury (TBI) in trauma patients revolves around preventing secondary injury and neurologic worsening (NW). Many invasive and noninvasive methods have been developed to quickly identify and monitor these patients. We hypothesized that we could predict NW on CT using noninvasive vital signs. METHODS: A prospective observational study of trauma patients age 18 years with severe TBI at a level I trauma center was performed over a 2-year period. CT head performed at 0, 6, and 24 hours post-admission were reviewed. Compared to baseline CT, NW at 6 and 24 hour was diagnosed using variables: contusion, ischemia, compression of basal cisterns, and midline shift. Physiologic variables collected between 0-6 hour and 6-24 hour time frames were used to predict NW diagnosed on CT at 6 and 24 hour. Multivariate logistic regression with leave-one-out crossvalidation was used to build predictive models. RESULTS: Thirty-nine patients underwent 114 CT head at 0, 6 and 24 hours of admission. Compared to baseline, 21/75 interval scans showed NW. A model using 3rd quartile systolic blood pressure (SBP) and 2nd quartile end tidal carbon dioxide (EtCO2) was able to predict NW with an receiver operating characteristic curve (ROC) of 0.83 and 0.78 for testing set (Figure).
RESULTS: There were 11,748 lines placed; mean duration of 8.3 days (median 6) with a total of 91 infections. Placement in an ICU was significantly associated with increased risk of infection 1.8% vs 0.5%, OR 3.7. Femoral lines had a nonsignificant trend to be less likely to be infected (0.4% vs 0.8% p¼0.2). PICCS were more likely then CVC and ports to be infected, 1% vs 0.59% and 0.61%, p¼.043. Lines that were infected were in longer; mean 7.3 vs 4.4 days, p¼.018 and confirmed by Wilcoxin. In a multivariate regression model predicting infection, ICU patients and line days had significant p-value p <.001, OR 4.3 and 1.07 respectively. Survival analysis did not yield an inflection point or threshold for removal.
Figure. Physiologic Models to Predict Neurologic Worsening ICP, Intracranial pressure; SBP, Systolic blood pressure; EtCO2, Endtidal carbondioxide; SpO2, oxygen saturation1
CONCLUSIONS: Central line infections remain a critical topic in healthcare. Unrelated to placement, and with no current guideline for empiric removal, we do not find evidence for a new threshold for empiric replacement. We believe this reinforces the need to
CONCLUSIONS: The model helps in predicting NW in trauma patients with TBI and helps in risk stratifying them. Low risk patients could avoid invasive intracranial monitoring and repeated interval monitoring by CT scans. The pilot study
RESULTS: Of the 385 qualifying patients, average age was 77.5 years and 51% were women. Average Injury Severity Score was 10.3 and inpatient mortality was 5.7%. Patients on the GeriTrauma service had higher rates of delirium screening (45% [35.3-55.4] vs 33% [25.2-40.2] and 20% [13.4-26.6] on GeriTrauma (n¼95), Trauma (n¼150) and Other (n¼140) respectively) and delirium diagnosis (36% [26.3-45.4] vs 14% [8.4-19.6] and 18% [11.5-24.2]) (Table 1). Geriatric consultation also increased involvement of physical therapy (95.8% [91.8-99.8] vs 71.3% [64.1-78.6] and 72.9% [65.5- 80.2]). There was no effect on length of stay. Documentation of goals of care discussions was low, and benzodiazepines were used for many patients. CONCLUSIONS: Geriatric consultation improves quality of care for trauma patients without increasing length of stay or mortality. Areas of further need include medication reconciliation and management, and goals of care documentation.
New Perspectives on Old Problems: Central Line Associated Blood Stream Infection after Initial Insertion Arielle Hodari, MD, Matthew Goodwin, Kaori Ito, MD, Nathan Schmoekel, Dionne J Blyden, MD, FACS, Jack Jordan, Ryan D Kather, Ilan S Rubinfeld, MD, FACS Henry Ford Hospital, Detroit, MI INTRODUCTION: Historically, interventions to prevent line infections were based on placement. As that is no longer true, we hypothesized there would be some duration where infection rates would rise and recommendations for replacement based on cumulative maintenance risk made. METHODS: All central lines from a single large teaching-hospital were analyzed (2014-2015). central venous catheters (CVC), PICC lines, and implanted ports were included. Line infections were labeled by infection control experts according to NHSN criterion. Data analyzed in R.
Scientific Poster Presentations: 2016 Clinical Congress
e93
remove lines promptly, and that ICU patients remain at highest risk for this adverse event. Noninvasive Prediction of Neuroworsening in Patints with Traumatic Brain Injury Nehu Parimi, Shiming Yang, PhD, Peter F Hu, PhD, Hsiao-Chi Li, PhDc, Ifeatu Onyekwelu, Leslie A Sult, Thomas M Scalea, MD, FACS, Deborah Stein, MD, MPH University of Maryland, Baltimore, MD INTRODUCTION: Management of trauma brain injury (TBI) in trauma patients revolves around preventing secondary injury and neurologic worsening (NW). Many invasive and noninvasive methods have been developed to quickly identify and monitor these patients. We hypothesized that we could predict NW on CT using noninvasive vital signs. METHODS: A prospective observational study of trauma patients age 18 years with severe TBI at a level I trauma center was performed over a 2-year period. CT head performed at 0, 6, and 24 hours post-admission were reviewed. Compared to baseline CT, NW at 6 and 24 hour was diagnosed using variables: contusion, ischemia, compression of basal cisterns, and midline shift. Physiologic variables collected between 0-6 hour and 6-24 hour time frames were used to predict NW diagnosed on CT at 6 and 24 hour. Multivariate logistic regression with leave-one-out crossvalidation was used to build predictive models. RESULTS: Thirty-nine patients underwent 114 CT head at 0, 6 and 24 hours of admission. Compared to baseline, 21/75 interval scans showed NW. A model using 3rd quartile systolic blood pressure (SBP) and 2nd quartile end tidal carbon dioxide (EtCO2) was able to predict NW with an receiver operating characteristic curve (ROC) of 0.83 and 0.78 for testing set (Figure).
RESULTS: There were 11,748 lines placed; mean duration of 8.3 days (median 6) with a total of 91 infections. Placement in an ICU was significantly associated with increased risk of infection 1.8% vs 0.5%, OR 3.7. Femoral lines had a nonsignificant trend to be less likely to be infected (0.4% vs 0.8% p¼0.2). PICCS were more likely then CVC and ports to be infected, 1% vs 0.59% and 0.61%, p¼.043. Lines that were infected were in longer; mean 7.3 vs 4.4 days, p¼.018 and confirmed by Wilcoxin. In a multivariate regression model predicting infection, ICU patients and line days had significant p-value p <.001, OR 4.3 and 1.07 respectively. Survival analysis did not yield an inflection point or threshold for removal.
Figure. Physiologic Models to Predict Neurologic Worsening ICP, Intracranial pressure; SBP, Systolic blood pressure; EtCO2, Endtidal carbondioxide; SpO2, oxygen saturation1
CONCLUSIONS: Central line infections remain a critical topic in healthcare. Unrelated to placement, and with no current guideline for empiric removal, we do not find evidence for a new threshold for empiric replacement. We believe this reinforces the need to
CONCLUSIONS: The model helps in predicting NW in trauma patients with TBI and helps in risk stratifying them. Low risk patients could avoid invasive intracranial monitoring and repeated interval monitoring by CT scans. The pilot study