Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge

Abstract

Objectives Long-term outcomes following traumatic brain injury (TBI) correlate with initial head injury severity and other acute factors. Hospital-acquired pneumonia (HAP) is a common complication in TBI. Little information exists regarding the significance of infectious complications on long-term outcomes post-TBI. We sought to characterize risks associated with HAP on outcomes 5 years post-TBI. Methods Ddata from the merger of an institutional trauma registry and the TBI Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale≥4), who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scaled-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into LOW (GOSE<6) and HIGH (GOSE≥6). Logistic regression was utilized to determine adjusted odds of LOW-GOSE associated with HAP after controlling for age, sex, head and overall injury severity, cranial surgery, Glasgow Coma Scale (GCS), ventilation days, and other important confounders. A general estimating equation (GEE) model was used to analyze all outcome observations simultaneously while controlling for within-patient correlation. Results A total of 141 individuals met inclusion criteria, with a 30% incidence of HAP. Individuals with and without HAP had similar demographic profiles, presenting vitals, head injury severity, and prevalence of cranial surgery. Individuals with HAP had lower presenting GCS. Logistic regression demonstrated that HAP was independently associated with LOW-GOSE scores at follow-up (1year: OR=6.39, 95%CI: 1.76-23.14, p=0.005; 2-years: OR=7.30, 95%CI 1.87-27.89, p=0.004; 5-years: OR=6.89, 95%CI: 1.42-33.39, p=0.017). Stratifying by GCS≤8 and early intubation, HAP remained a significant independent predictor of LOW-GOSE in all strata. In the GEE model, HAP continued to be an independent predictor of LOW-GOSE (OR: 4.59; 95%CI: 1.82-11.60′ p=0.001). Conclusion HAP is independently associated with poor outcomes in severe-TBI extending 5 years post-injury. This suggests precautions should be taken to reduce the risk of HAP in individuals with severe-TBI. Level III Retrospective Study Pneumonia TBI

Early-Onset Ventilator-Associated Pneumonia in Patients with Severe Traumatic Brain Injury: Incidence, Risk Factors, and Consequences in Cerebral Oxygenation and Outcome

“…We demonstrated that, in patients with severe TBIs, EOVAP was associated with an approximately three-fold increase in the odds of receiving a low GOS score at 1 year. These results were consistent with those recently presented by Kesinger and colleagues [39]. Indeed, in their study, which included 141 individuals with severe TBIs, the authors showed that hospital-acquired pneumonia (early-or late-onset pneumonia) was independently associated with a poor 1-year outcome, based on the GOSExtended score (adjusted OR 6.39; 95% CI 1.76-23.14) [39].…”

Probabilistic Matching Approach to Link Deidentified Data from a Trauma Registry and a Traumatic Brain Injury Model System Center

“…Though it is a small dataset, the linked dataset has yielded potentially high impact findings already. 19 With this algorithm, we obtained good sensitivity with a very high PPV. This method can be employed to link patients from other TBIMS centers with de-identified data to their corresponding trauma registries whose de-identified data are fed into the NTDB.…”

“…19 Also, the methodology and matching criteria have been used to link data from all TBIMS centers with acute care data from the NTDB, and we generated a database that includes matched records for over 3500 individuals in the TBIMS National Database. We have used this matched dataset to examine the influence of extracranial injury on mental health outcomes, 28 and we will explore how other aspects of the acute trauma complex, comorbidities, as well as acute trauma complications and treatments, influence health care utilization and long term outcomes.…”

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

“…Several studies have reported an association between pneumonia and prognosis in the patient regardless of underlying illness. 11,12 One recent retrospective study even described the influence of pneumonia on functional outcome up to 5 years after insult. 11 In our study, pneumonia was not a predictor of an unfavorable long-term outcome; however, this might be dependent on multiple factors such as the beginning of treatment, the type of microorganism, the type of pneumonia, and the general condition of the patient.…”