Sepsis in Traumatic Brain Injury: Epidemiology and Outcomes
CCCF ePoster library. Anderson D. Nov 9, 2018; 233407
Dustin Anderson
Dustin Anderson
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Abstract
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Introduction: Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality in North America. Roughly 25% of all patients with TBI die, with nearly 20% dying prior to hospital admission. Estimates of in-hospital mortality in patients with TBI vary widely. A number of risk factors for in-hospital mortality have been previously identified (age, severity of injury, comorbidity burden, ethnicity); however, few studies have investigated the role of sepsis in TBI patient outcomes.

 

Objectives:To describe the epidemiology and outcomes of patients with TBI and sepsis in a quaternary care intensive care unit.

 

Methods: Patients admitted with TBI (identified by ICD10CA codes) to the University of Alberta from January 1, 2012 through December 31, 2016 were included in the analysis. Variables of interest were abstracted from electronic medical records. In addition, charts of patients with TBI and sepsis (also identified using ICD10CA codes) were retrospectively reviewed for co-morbidities, sepsis source, and microbial etiology. Independent predictors of ICU and hospital mortality were examined using logistic regression modeling.  

 

Results: 486 patients with TBI were identified. Mean age was 45.7 ±18.6 years. 370 (76%) patients were male. Acute Physiology and Chronic Health Evaluation (APACHE II), Glasgow Coma Scale (GCS), and Sequential Organ Failure Assessment (SOFA) scores were 18.4 ± 7.6, 8.5 ± 4.2, and 6.4 ± 3.4, respectively, at the time of ICU admission. Median length-of-stay (LOS) in the ICU was 3.9 days (IQR 1.7-8.6) and in hospital was 15.7 days (IQR 5.1-31.8). 86 (17.7%) patients died in the ICU, while 119 (24.7%) died in the hospital. 

 

Of the 486 TBI patients, 16 (3.3%) were identified as having sepsis. Pneumonia was the most common sepsis source (n=15). Additional sources included skin and soft tissue infection (n=1), colitis (n=1), and urinary tract infection (n=1). Staphylococcus aureuswas the most common pathogen (12/16 [75%] patients) – of which nine were methicillin-sensitive and three were methicillin-resistant. On univariate analysis, TBI patients with sepsis had higher SOFA scores (9.1 ± 3.2 versus 6.4 ± 3.4; p= 0.002) and longer ICU LOS (16.8 ± 18.4 days versus 5.8 ± 5.9 days; p=0.03) when compared to patients without sepsis.  On logistic regression, sepsis was not independently associated with ICU (aOR 0.6; 95%CI 0.1-2.7; p= 0.51) or hospital (aOR 0.9; 95%CI 0.2-3.5; p= 0.89) mortality. Age (aOR 1.03; 95%CI 1.01-1.04; p= 0.004 for hospital mortality), GCS (aOR 0.76; 95%CI 0.67-0.86; p<0.001 for ICU mortality and0.79; 95%CI 0.71-0.88; p<0.001 for hospital mortality), and APACHE II score (aOR 1.14; 95%CI 1.06-1.23; p<0.001 for ICU mortality and 1.18; 95%CI 1.10-1.27; p<0.001 for hospital mortality) were independently associated with mortality.

 

Conclusion: Sepsis in patients with TBI is rare. Previous studies have shown sepsis to be a predictor of mortality in patients with TBI; however, there was no association in our cohort. As with previous studies, age, GCS, and severity of illness (APACHE II score) were independent predictors of mortality. Sepsis was associated with increased ICU LOS in TBI when compared to non-septic TBI patients.

 


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