Infection rates, fevers, and associated factors in pediatric severe traumatic brain injury.

Abstract Infections can increase medical costs and worsen patient outcomes. Our aims in pediatric severe traumatic brain injury (sTBI) patients were to determine the infection and fever rates, and to report on associated clinical, imaging, treatment, and outcome factors. We included 180 sTBI patients (presedation Glasgow Coma Scale ≤ 8 and Maximum Abbreviated Injury Scale ≥ 4) admitted to our pediatric intensive care unit. Overall, 17% of sTBI patients (n=30 of 180) developed 36 infections, consisting primarily of urinary tract infections (UTIs; n=13 of 36) and ventilator-associated pneumonias (n=11 of 36). Most infections were nosocomial, occurring >2 days after admission. Fever was found in 36% of sTBI patients during the first few hospital days, but fewer than 7% of patients had infections. Infections occurred more frequently in sTBI patients who were older, heavier, and with a higher injury severity score (ISS; p<0.05). Admission head computed tomography imaging abnormalities (subarachnoid hemorrhage, intraventricular hemorrhage, and diffuse axonal injury), placement of an intracranial pressure (ICP) monitor, and administration of ICP-lowering therapies (hypertonic saline, mannitol, and thiopental) were associated with infections (p<0.05). Those with infections had fewer ventilator-free days, greater hospital lengths of stays, and were less likely to be discharged home. Logistic regression demonstrated that infections were independently associated with use of hypertonic saline (odds ratio [OR], 4.46; p=0.001) and higher ISS (OR, 1.05; p=0.028). In summary, infections were prevalent in sTBI patients and were associated with greater head-imaging abnormalities and use of ICP-lowering therapies. Hypertonic saline administration was strongly associated with infection, but further analyses are required to determine the nature of this relationship. Fever was a poor indicator of infection after sTBI.