Association of Facility Level Factors and Outcomes from Hospital-Acquired Pneumonia in Patients with Isolated Severe Traumatic Brain Injury
Traumatic brain injury (TBI) is a major public heath problem and leading cause of death and disability worldwide. While secondary brain injuries are known to worsen mortality in TBI, very little literature exists on the role of hospital-acquired infections in isolated TBI. Among adults with isolated severe TBI, we describe the cumulative incidence of hospital-acquired pneumonia and analyze the association between hospital characteristics and the development of hospital-acquired pneumonia.
We examined data from the National Trauma Databank (NTDB), excluding children, patients with non-isolated TBI, and patients hospitalized for less than one week. We describe clinical and demographic characteristics of patients, stratified by facility characteristics and the presence of hospital acquired pneumonia. We used multivariable Poisson regression to analyze the association between hospital characteristics and the development of hospital-acquired pneumonia.
20,604 patients were included in our analysis. The cumulative incidence of hospital-acquired pneumonia was 17.3%. Among patients that developed hospital-acquired pneumonia, the cumulative mortality was 18.2%. On multivariate analysis, compared to small hospitals (<200 beds), patients at medium hospitals (201-400 beds) had a 28% reduced risk of hospital-acquired pneumonia (Relative risk 0.72, 95% CI: 0.53 - 0.96) and patients at large hospitals (>400 beds) had a 34% reduced risk of hospital-acquired pneumonia (Relative risk 0.66, 95% CI: 0.49 - 0.88).
Hospital-acquired pneumonia is common in patients with isolated severe TBI, and larger hospitals conferred a decreased risk for the development of hospital-acquired pneumonia. Future research should aim to explore the mechanism of the impact of facility characteristics on infectious complications, examine the utility of pneumonia prevention measures in the TBI population, and determine the impact of in-hospital infectious complications on patient-level outcomes in isolated severe TBI.