Effects of hospital-acquired pneumonia on long-term recovery and hospital resource utilization following moderate to severe traumatic brain injury
Journal of Trauma and Acute Care Surgery
Year, Volume, Issue, Page(s):
, 88, 4, 491-500
Study determined the long-term effects of hospital-acquired pneumonia (HAP) on disability after moderate-to-severe traumatic brain injury (TBI) and compared hospital resource utilization metrics between moderate-to-severe TBI survivors with and without HAP. The National Trauma Databank (NTDB) and TBI Model Systems (TBI-MS) were merged to derive a cohort of 3,717 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), collected at 1, 2, and 5 years post injury. 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. Individuals with HAP had 34 percent 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. The findings suggest that 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.
Kumar, Raj G. |Kesinger, Matthew R. |Juengst, Shannon B. |Brooks, Maria M. |Fabio, Anthony |Dams-O'Connor, Kristen |Pugh, Mary Jo |Sperry, Jason L. |Wagner, Amy K.|