C-reactive protein in the early diagnosis of pneumonia complicating severe blunt chest trauma


Becem Trabelsi
Sahar Ghorbel
Rania Ben Rabeh
Mahdi Bouassida
Mechaal Ben Ali


Background: The early diagnosis of pneumonia following severe blunt chest trauma (SBCT) allows the early prescription of antibiotics and initiation of adequate supportive care.

Aim: To assess the usefulness of C-reactive protein (CRP) in the early diagnosis of pneumonia complicating SBCT.

Methods: We conducted a prospective study of patients admitted to trauma intensive care unit for SBCT between January 2020 and February 2023. Patients were divided into two groups according to whether or not they developed pneumonia. The CRP levels were monitored daily.

Results: One hundred sixty-seven patients were included. Pneumonia occurred in 40.1% of patients within a median of 5 days. We found statistically significant difference in mean CRP levels between groups from day 3 to day 9 following trauma. The increase in CRP level on the 4th day from a value greater than or equal to 192 mg/L was a marker of early diagnosis of pneumonia (sensitivity 80.6%; specificity 80.8%).

Conclusion: Daily CRP measurement from the 3rd day following SBCT may be useful for early diagnosis of pneumonia complicating SBCT.


C-reactive protein, Complications, Multiple trauma, Thoracic injuries



  1. Kim M, Moore JE. Chest Trauma: Current recommendations for rib fractures, pneumothorax, and other injuries. Curr Anesthesiol Rep 2020;10(1):61‑8.
  2. Wutzler S, Bläsius FM, Störmann P, et al. Pneumonia in severely injured patients with thoracic trauma: results of a retrospective observational multi-centre study. Scand J Trauma Resusc Emerg Med 2019;27(1):31.
  3. Almirall J, Bolíbar I, Toran P, et al. Contribution of c-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest 2004;125(4):1335‑42.
  4. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016;63(5):e61‑111.
  5. Hofman M, Andruszkow H, Kobbe P, et al. Incidence of post-traumatic pneumonia in poly-traumatized patients: identifying the role of traumatic brain injury and chest trauma. Eur J Trauma Emerg Surg 2020;46(1):11‑9.
  6. Grubmüller M, Kerschbaum M, Diepold E, et al. Severe thoracic trauma – still an independent predictor for death in multiple injured patients? Scand J Trauma Resusc Emerg Med 2018;26(1):6.
  7. Schellenberg M, Inaba K. Pneumonia in trauma patients. Curr Trauma Rep 2017;3(4):308‑14.
  8. Xu LB, Yue JK, Korley F, et al. High-Sensitivity C-reactive protein is a prognostic biomarker of six-month disability after traumatic brain injury: results from the TRACK-TBI study. J Neurotrauma 2021;38(7):918‑27.
  9. Vanderschueren S, Deeren D, Knockaert DC, et al. Extremely elevated C-reactive protein. Eur J of Intern Med 2006;17(6):430‑3.
  10. Póvoa P, Coelho L, Almeida E, et al. Early identification of intensive care unit-acquired infections with daily monitoring of C-reactive protein: a prospective observational study. Crit Care 2006;10(2):R63.
  11. Chiumello D, Coppola S, Froio S, et al. Noninvasive ventilation in chest trauma: systematic review and meta-analysis. Intensive Care Med 2013;39(7):1171‑80.