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Nosocomial Infection Following Severe Traumatic Injury in Children
Eric A Sribnick1,2,3, Josey Hensley3, Melissa Moore-Clingenpeel3
1Department of Surgery, Division of Neurosurgery, Nationwide Children's Hospital, Columbus, OH.
Insights
Critically ill children with polytrauma and traumatic brain injury face higher rates of nosocomial infections. Understanding these risks is crucial for improving outcomes in pediatric trauma patients.
Area of Science:
- Pediatric Critical Care Medicine
- Trauma Surgery
- Infectious Disease Epidemiology
Background:
- Nosocomial infections are a significant cause of morbidity in critically injured children.
- Risk factors for hospital-acquired infections in pediatric trauma patients, particularly those with traumatic brain injury, are not well understood.
Purpose of the Study:
- To investigate the hypothesis that critically ill pediatric trauma patients with traumatic brain injury exhibit higher rates of nosocomial infection compared to those without traumatic brain injury.
Main Methods:
- Retrospective case-control study conducted at a single institution's Pediatric Intensive Care Unit (PICU).
- Included patients under 18 admitted for traumatic injuries for at least 48 hours between September 2008 and December 2015.
- Classified patients into three groups: isolated traumatic brain injury, traumatic injury without traumatic brain injury, and polytrauma with traumatic brain injury.
Main Results:
- Out of 203 patients, 27 developed nosocomial infections.
- Patients with polytrauma and traumatic brain injury had a significantly higher infection rate (30%) compared to isolated traumatic brain injury (6%) or trauma without traumatic brain injury (9%) (p < 0.001).
- This finding remained consistent across univariate, multivariable, and adjusted analyses.
Conclusions:
- Nosocomial infections are more prevalent in critically ill pediatric trauma patients with polytrauma and traumatic brain injury.
- This study highlights traumatic brain injury, especially in the context of polytrauma, as a key risk factor for hospital-acquired infections in this vulnerable population.
Objectives:
Nosocomial infection is a common source of morbidity in critically injured children including those with traumatic brain injury. Risk factors for nosocomial infection in this population, however, are poorly understood. We hypothesized that critically ill pediatric trauma patients with traumatic brain injury would demonstrate higher rates of nosocomial infection than those without traumatic brain injury.
Design:
Retrospective case-control study.
Setting:
PICU, single institution.
Patients:
Patients under 18 years old who were admitted to the PICU for at least 48 hours following a traumatic injury were included. Patients were admitted between September 2008 and December 2015. Patients with the following injury types were excluded: thermal injury, drowning, hanging/strangulation, acute hypoxic ischemic encephalopathy, or nonaccidental trauma. Data collected included demographics, injury information, hospital and PICU length of stay, vital signs, laboratory data, insertion and removal dates for invasive devices, surgeries performed, transfusions of blood products, and microbiology culture results. Initial Pediatric Risk of Mortality III and Pediatric Logistic Organ Dysfunction-2 scores were determined. Patients were classified as having: 1) an isolated traumatic brain injury, 2) a traumatic injury without traumatic brain injury, or 3) polytrauma with traumatic brain injury.
Interventions:
None.
Measurements And Main Results:
Two hundred three patients were included in the analyses, and 27 patients developed a nosocomial infection. Patients with polytrauma with traumatic brain injury demonstrated a significantly higher infection rate (30%) than patients with isolated traumatic brain injury (6%) or traumatic injury without traumatic brain injury (9%) (p < 0.001). This increased rate of nosocomial infection was noted on univariate analysis, on multivariable analysis, and after adjusting for other risk factors.
Conclusions:
In this single-center, retrospective analysis of critically ill pediatric trauma patients, nosocomial infections were more frequently observed in patients admitted following polytrauma with traumatic brain injury than in patients with isolated traumatic brain injury or trauma without traumatic brain injury.
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