Risk of Infection and Sepsis in Pediatric Patients with Traumatic Brain Injury Admitted to Hospital Following Major Trauma

Anjli Pandya,Jonathan Guilfoyle,Diane Moser,Sherry Macgillivray,Jaime Blackwood,Graham C Thompson,Ari R Joffe,Kathleen Helen Chaput,Andrea Schertzer

doi:10.1038/s41598-018-28189-0

Abstract

Head injury accounts for 29% of all traumatic deaths in children. Sepsis is significantly associated with an increased risk of mortality in adult traumatic brain injury patients. In the pediatric population, this relationship is not well understood. The objective of this study was to compare the proportion of pediatric traumatic brain injury (TBI) patients and trauma patients without brain injury (NTBI) who developed sepsis or any infection during their index hospital admission. We performed a retrospective study of all trauma patients <18 years of age, admitted to trauma centres in Alberta, Canada from January 1, 2003 to December 31, 2012. Patients who died within 24 hrs of trauma (n = 147) and those with burns as the primary mechanism of injury (n = 53) were excluded. Hospital admission data for the remaining 2556 patients was analyzed. 1727 TBI patients and 829 NTBI patients were included. TBI was associated with lower odds of developing sepsis (OR 0.32 95% CI 0.14–0.77 p = 0.011). TBI was not found to be independently associated with developing any infectious complication after adjusting for confounding by Injury Severity Score (OR 1.25 95% CI 0.90–1.74 p = 0.180). These relationships warrant further study.

Highlights

In the pediatric population, the relationship between trauma, brain injury and sepsis is not as well understood
This study aimed to explore the patterns of sepsis and infection in pediatric traumatic brain injury patients through a direct comparison of the proportion of pediatric traumatic brain injury (TBI) patients and trauma patients without brain injury (NTBI) who developed sepsis during the index hospital admission
Contrary to previous reported findings in the adult trauma population that an independent relationship exists between TBI and sepsis, we identified reduced odds of sepsis between TBI and NTBI patients in our pediatric cohort

Summary

Introduction

The relationship between trauma, brain injury and sepsis is not as well understood. An improved understanding of the relationship between traumatic brain injury, infection and sepsis in pediatric patients is necessary to ensure that pediatric trauma victims are optimally managed both in hospital and after discharge. This study aimed to explore the patterns of sepsis and infection in pediatric traumatic brain injury patients through a direct comparison of the proportion of pediatric traumatic brain injury (TBI) patients and trauma patients without brain injury (NTBI) who developed sepsis during the index hospital admission. The secondary objectives of the study were to compare the proportion of TBI and NTBI patients who developed any infectious complication, as well as to describe the demographics, clinical characteristics and mortality of pediatric TBI patients

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