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Double Jeopardy: Use of Contact Isolation in Trauma Patients is Significantly Associated with the Development of Ileus

Cristopher R Reed, Mark E Hamill, Sandy L Fogel, Christopher C Baker and Bryan R Collier

Background: Trauma patients are at risk for malnutrition due to metabolic needs associated with injuries and surgery. Ileus may result in improper withholding of vital enteral nutrition. Contact isolation precautions (CI) are a set of restrictions intended to prevent spread of certain organisms. Our goal was to study a possible association between CI and development of ileus among trauma patients.

Methods: Our Level I trauma center's institutional trauma database was queried for all patients evaluated between January 1, 2011 and December 31, 2012. Data collected included demographics, comorbidities, and development of ileus. A separate infection control database was used to determine patients on CI. Unadjusted relationships were determined by chi-square. Logistic regression was then used to adjust for patient and injury characteristics.

Results: A total of 4,423 trauma patients were evaluated during the study period; of these, 4,317 (97.6%) patients had complete records and were analyzed. CI was in place for 251 (5.8%) patients; 4,066 (94.2%) were not isolated. In the CI group, 14 (5.6%) had ileus vs. 74 (1.8%) in the non-CI group (p<0.0001; OR 3.19; 95% CI 1.77-5.73). Next, logistic regression was used to adjust for potential confounders. Gender, ISS, and CI were all statistically significant (p<0.05) in their association with ileus.

Conclusion: The use of CI in trauma patients is significantly associated with the development of ileus. A growing body of evidence suggests that CI among this population, which is already at greater risk of malnutrition and caloric deficit, should be re-evaluated.