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Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge.
J Trauma Acute Care Surg. 2015 Feb; 78(2):396-402.JT

Abstract

BACKGROUND

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. Limited information exists regarding the significance of infectious complications on long-term outcomes after TBI. We sought to characterize risks associated with HAP on outcomes 5 years after TBI.

METHODS

This study involved data from the merger of an institutional trauma registry and the Traumatic Brain Injury Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale [AIS] score ≥ 4) who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scale-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into low (GOSE score < 6) and high (GOSE score ≥ 6). Logistic regression was used to determine adjusted odds of low GOSE score associated with HAP after controlling for age, sex, head and overall injury severity, cranial surgery, Glasgow Coma Scale (GCS) score, ventilation days, and other important confounders. A general estimating equation 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 score. Logistic regression demonstrated that HAP was independently associated with low GOSE scores at follow-up (1 year: odds ratio [OR], 6.39; 95% confidence interval [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 score of 8 or lower and early intubation, HAP remained a significant independent predictor of low GOSE score in all strata. In the general estimating equation model, HAP continued to be an independent predictor of low GOSE score (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 after injury. This suggests that precautions should be taken to reduce the risk of HAP in individuals with severe TBI.

LEVEL OF EVIDENCE

Prognostic study, level III.

Authors+Show Affiliations

From the Division of Trauma and General Surgery (J.C.P., A.P.P., T.R.B., J.L.S.), Department of Surgery, and Department of Physical Medicine and Rehabilitation (R.G.K., A.K.W.), School of Medicine (M.R.K.), University of Pittsburgh, Pittsburgh, Pennsylvania.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25757128

Citation

Kesinger, Matthew Ryan, et al. "Hospital-acquired Pneumonia Is an Independent Predictor of Poor Global Outcome in Severe Traumatic Brain Injury Up to 5 Years After Discharge." The Journal of Trauma and Acute Care Surgery, vol. 78, no. 2, 2015, pp. 396-402.
Kesinger MR, Kumar RG, Wagner AK, et al. Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge. J Trauma Acute Care Surg. 2015;78(2):396-402.
Kesinger, M. R., Kumar, R. G., Wagner, A. K., Puyana, J. C., Peitzman, A. P., Billiar, T. R., & Sperry, J. L. (2015). Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge. The Journal of Trauma and Acute Care Surgery, 78(2), 396-402. https://doi.org/10.1097/TA.0000000000000526
Kesinger MR, et al. Hospital-acquired Pneumonia Is an Independent Predictor of Poor Global Outcome in Severe Traumatic Brain Injury Up to 5 Years After Discharge. J Trauma Acute Care Surg. 2015;78(2):396-402. PubMed PMID: 25757128.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge. AU - Kesinger,Matthew Ryan, AU - Kumar,Raj G, AU - Wagner,Amy K, AU - Puyana,Juan Carlos, AU - Peitzman,Andrew P, AU - Billiar,Timothy R, AU - Sperry,Jason L, PY - 2015/3/11/entrez PY - 2015/3/11/pubmed PY - 2015/5/12/medline SP - 396 EP - 402 JF - The journal of trauma and acute care surgery JO - J Trauma Acute Care Surg VL - 78 IS - 2 N2 - BACKGROUND: 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. Limited information exists regarding the significance of infectious complications on long-term outcomes after TBI. We sought to characterize risks associated with HAP on outcomes 5 years after TBI. METHODS: This study involved data from the merger of an institutional trauma registry and the Traumatic Brain Injury Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale [AIS] score ≥ 4) who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scale-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into low (GOSE score < 6) and high (GOSE score ≥ 6). Logistic regression was used to determine adjusted odds of low GOSE score associated with HAP after controlling for age, sex, head and overall injury severity, cranial surgery, Glasgow Coma Scale (GCS) score, ventilation days, and other important confounders. A general estimating equation 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 score. Logistic regression demonstrated that HAP was independently associated with low GOSE scores at follow-up (1 year: odds ratio [OR], 6.39; 95% confidence interval [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 score of 8 or lower and early intubation, HAP remained a significant independent predictor of low GOSE score in all strata. In the general estimating equation model, HAP continued to be an independent predictor of low GOSE score (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 after injury. This suggests that precautions should be taken to reduce the risk of HAP in individuals with severe TBI. LEVEL OF EVIDENCE: Prognostic study, level III. SN - 2163-0763 UR - https://www.unboundmedicine.com/medline/citation/25757128/Hospital_acquired_pneumonia_is_an_independent_predictor_of_poor_global_outcome_in_severe_traumatic_brain_injury_up_to_5_years_after_discharge_ L2 - http://dx.doi.org/10.1097/TA.0000000000000526 DB - PRIME DP - Unbound Medicine ER -