Raj G Kumar1, Matthew R Kesinger, Shannon B Juengst, Maria M Brooks, Anthony Fabio, Kristen Dams-O'Connor, Mary Jo Pugh, Jason L Sperry, Amy K Wagner. 1. From the Department of Epidemiology (R.G.K., M.M.B., A.F.), Department of Physical Medicine and Rehabilitation (R.G.K., M.R.K., A.K.W.), and Department of Surgery (M.R.K., J.S.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Physical Medicine and Rehabilitation (S.B.J.), and Department of Rehabilitation Counseling (S.B.J.), UT Southwestern, Dallas, Texas; Department of Epidemiology (M.M.B), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Rehabilitation Medicine (K.D.-O.'C.), and Department of Neurology (K.D.-O.'C.), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Internal Medicine Epidemiology Division (M.J.P.), University of Utah, Salt Lake City, Utah; Clinical and Translational Science Institute (A.K.W.), Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, and Safar Center for Resuscitation Research (A.K.W.), University of Pittsburgh, Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: Individuals with traumatic brain injury (TBI) have extended inpatient hospital stays that include prolonged mechanical ventilation, increasing risk for infections, including pneumonia. Studies show the negative short-term effects of hospital-acquired pneumonia (HAP) on hospital-based outcomes; however, little is known of its long-term effects. METHODS: A prospective cohort study was conducted. National Trauma Databank and Traumatic Brain Injury Model Systems were merged to derive a cohort of 3,717 adults with moderate-to-severe TBI. Exposure data were gathered from the National Trauma Databank, and outcomes were gathered from the Traumatic Brain Injury Model Systems. The primary outcome was the Glasgow Outcome Scale-Extended (GOS-E), which was collected at 1, 2, and 5 years postinjury. The GOS-E was categorized as favorable (>5) or unfavorable (≤5) outcomes. A generalized estimating equation model was fitted estimating the effects of HAP on GOS-E over the first 5 years post-TBI, adjusting for age, race, ventilation status, brain injury severity, injury severity score, thoracic Abbreviated Injury Scale score of 3 or greater, mechanism of injury, intraventricular hemorrhage, and subarachnoid hemorrhage. RESULTS: Individuals with HAP had a 34% (odds ratio, 1.34; 95% confidence interval, 1.15-1.56) increased odds for unfavorable GOS-E over the first 5 years post-TBI compared with individuals without HAP, after adjustment for covariates. There was a significant interaction between HAP and follow-up, such that the effect of HAP on GOS-E declined over time. Sensitivity analyses that weighted for nonresponse bias and adjusted for differences across trauma facilities did not appreciably change the results. Individuals with HAP spent 10.1 days longer in acute care and 4.8 days longer in inpatient rehabilitation and had less efficient functional improvement during inpatient rehabilitation. CONCLUSION: Individuals with HAP during acute hospitalization have worse long-term prognosis and greater hospital resource utilization. Preventing HAP may be cost-effective and improve long-term recovery for individuals with TBI. Future studies should compare the effectiveness of different prophylaxis methods to prevent HAP. LEVEL OF EVIDENCE: Prospective cohort study, level III.
BACKGROUND: Individuals with traumatic brain injury (TBI) have extended inpatient hospital stays that include prolonged mechanical ventilation, increasing risk for infections, including pneumonia. Studies show the negative short-term effects of hospital-acquired pneumonia (HAP) on hospital-based outcomes; however, little is known of its long-term effects. METHODS: A prospective cohort study was conducted. National Trauma Databank and Traumatic Brain Injury Model Systems were merged to derive a cohort of 3,717 adults with moderate-to-severe TBI. Exposure data were gathered from the National Trauma Databank, and outcomes were gathered from the Traumatic Brain Injury Model Systems. The primary outcome was the Glasgow Outcome Scale-Extended (GOS-E), which was collected at 1, 2, and 5 years postinjury. The GOS-E was categorized as favorable (>5) or unfavorable (≤5) outcomes. A generalized estimating equation model was fitted estimating the effects of HAP on GOS-E over the first 5 years post-TBI, adjusting for age, race, ventilation status, brain injury severity, injury severity score, thoracic Abbreviated Injury Scale score of 3 or greater, mechanism of injury, intraventricular hemorrhage, and subarachnoid hemorrhage. RESULTS: Individuals with HAP had a 34% (odds ratio, 1.34; 95% confidence interval, 1.15-1.56) increased odds for unfavorable GOS-E over the first 5 years post-TBI compared with individuals without HAP, after adjustment for covariates. There was a significant interaction between HAP and follow-up, such that the effect of HAP on GOS-E declined over time. Sensitivity analyses that weighted for nonresponse bias and adjusted for differences across trauma facilities did not appreciably change the results. Individuals with HAP spent 10.1 days longer in acute care and 4.8 days longer in inpatient rehabilitation and had less efficient functional improvement during inpatient rehabilitation. CONCLUSION: Individuals with HAP during acute hospitalization have worse long-term prognosis and greater hospital resource utilization. Preventing HAP may be cost-effective and improve long-term recovery for individuals with TBI. Future studies should compare the effectiveness of different prophylaxis methods to prevent HAP. LEVEL OF EVIDENCE: Prospective cohort study, level III.
Authors: Kevin R Kasten; Holly S Goetzman; Maria R Reid; Alison M Rasper; Samuel G Adediran; Chad T Robinson; Cindy M Cave; Joseph S Solomkin; Alex B Lentsch; Jay A Johannigman; Charles C Caldwell Journal: BMC Immunol Date: 2010-01-25 Impact factor: 3.615
Authors: M Balestreri; M Czosnyka; D A Chatfield; L A Steiner; E A Schmidt; P Smielewski; B Matta; J D Pickard Journal: J Neurol Neurosurg Psychiatry Date: 2004-01 Impact factor: 10.154
Authors: Patrick T Lee; Laura K Krecko; Stephanie Savage; Ann P O'Rourke; Hee Soo Jung; Angela Ingraham; Ben L Zarzaur; John E Scarborough Journal: J Trauma Acute Care Surg Date: 2022-04-08 Impact factor: 3.697