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Infection rates, fevers, and associated factors in pediatric severe traumatic brain injury

Ibrahim M Alharfi1, Tanya Charyk Stewart, Ibrahim Al Helali

  • 11 Department of Paediatrics, Western University , London, Ontario, Canada .

Journal of Neurotrauma
|October 8, 2013
PubMed

Insights

Infections are common in pediatric severe traumatic brain injury (sTBI) patients, linked to higher injury severity and specific treatments like hypertonic saline. Fever is an unreliable indicator of infection in these cases.

Area of Science:

  • Pediatric critical care medicine
  • Neurocritical care
  • Infectious disease epidemiology

Background:

  • Infections complicate patient outcomes and increase healthcare costs in severe traumatic brain injury (sTBI).
  • Understanding infection rates and associated factors in pediatric sTBI is crucial for improving care.
  • Fever is often monitored but its utility as an infection indicator in sTBI needs clarification.

Purpose of the Study:

  • To determine infection and fever rates in pediatric severe traumatic brain injury (sTBI) patients.
  • To identify clinical, imaging, treatment, and outcome factors associated with infections in this population.
  • To evaluate the relationship between specific therapies, such as intracranial pressure (ICP)-lowering agents, and infection development.

Main Methods:

  • Retrospective analysis of 180 pediatric sTBI patients admitted to a pediatric intensive care unit.
  • Data collection included patient demographics, injury severity (Glasgow Coma Scale, Abbreviated Injury Scale), imaging findings, ICP monitoring, treatments, and infection development.
  • Statistical analysis, including logistic regression, was used to identify factors associated with infection.

Main Results:

  • 17% of sTBI patients developed infections, primarily urinary tract infections and ventilator-associated pneumonias.
  • Infections were more common in older, heavier patients with higher injury severity scores (ISS).
  • Head CT abnormalities, ICP monitoring, and ICP-lowering therapies (especially hypertonic saline) were associated with increased infection risk. Hypertonic saline use showed a strong association (OR, 4.46).
  • Infected patients had worse outcomes, including fewer ventilator-free days and longer hospital stays. Fever was present in 36% but infections in <7%.

Conclusions:

  • Infections are prevalent in pediatric sTBI patients and are associated with significant head injury and intensive treatments.
  • The use of hypertonic saline is strongly linked to infection development, warranting further investigation.
  • Fever is an unreliable marker for infection in pediatric sTBI patients, and clinical vigilance for infection is essential.

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