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Prognostic Factors Associated with Pneumonia in Patients with Traumatic Brain Injury: A Systematic Review and
Talia Mia Bitonti1,2, Kevin M Durr3,4, Bram Rochwerg5,6
1Department of Critical Care, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. taliabitonti@outlook.com.
Neurocritical Care
|February 25, 2026
Summary
Pneumonia is common in traumatic brain injury (TBI) patients. Male sex, lower Glasgow Coma Scale, chest injury, barbiturate use, and mechanical ventilation increase risk, while early antibiotics may reduce incidence.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Traumatic brain injury (TBI) is a significant global health issue.
- Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are common complications in TBI patients.
- These infections can lead to prolonged hospital stays and increased morbidity.
Purpose of the Study:
- To systematically review and meta-analyze prognostic factors for pneumonia development in hospitalized TBI patients.
- To identify key predictors associated with HAP or VAP in acute TBI.
Main Methods:
- Comprehensive literature search of Medline and Embase databases.
- Inclusion of studies investigating prognostic factors for HAP/VAP in adult TBI patients with adjusted analyses.
- Pooled adjusted odds ratios (aORs) using a random-effects model and assessed certainty using GRADE.
Main Results:
- Analysis of 24 studies with 34,841 patients identified several risk factors.
- Factors associated with increased pneumonia risk include male sex (aOR 1.52), lower Glasgow Coma Scale (aOR 6.36), chest injury severity (aOR 1.56), barbiturate use (aOR 1.83), and mechanical ventilation (aOR 6.22).
- Early antibiotic use showed a potential protective effect (aOR 0.40).
Conclusions:
- Pneumonia incidence in TBI patients is multifactorial, influenced by patient demographics, injury severity, and medical interventions.
- Identifying these risk factors is crucial for developing targeted early interventions.
- Reducing pneumonia can improve outcomes for patients with TBI.
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