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Effects of Hospital-Acquired Pneumonia on Long-Term Recovery and Hospital Resource Utilization Following Moderate to Severe Traumatic Brain Injury
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April 2020
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Source: J Trauma Acute Care Surg. 88(4):491-500
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Details:
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Alternative Title:J Trauma Acute Care Surg
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Personal Author:
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Description:Background:
Individuals with Traumatic Brain Injury (TBI) have extended inpatient hospital stays that includes 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:
Prospective cohort study. National Trauma Databank (NTDB) and Traumatic Brain Injury Model Systems (TBI-MS) were merged to derive a cohort of n=3717 adults with moderate-to-severe TBI. Exposure data were gathered from the NTDB, and outcomes were gathered from the TBI-MS. The primary outcome was the Glasgow Outcome Scale-Extended (GOS-E), which was collected at 1, 2 and 5 years post-injury. 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 five years post-TBI, adjusting for age, race, ventilation status, brain injury severity, injury severity score (ISS), thoracic Abbreviated Injury Scale score ≥3, mechanism of injury, intraventricular hemorrhage, and subarachnoid hemorrhage.
Results:
Individuals with HAP had a 34% (OR=1.34, 95% CI 1.15, 1.56) increased odds for unfavorable GOS-E over the first five years post-TBI compared to 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 non-response 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.
Conclusions:
Individuals with HAP during acute hospitalization have worse long-term prognosis and greater hospital 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.
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Source:
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Pubmed ID:31804412
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Pubmed Central ID:PMC7802881
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Funding:
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Volume:88
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Issue:4
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