257. Nosocomial Infection Following Severe Traumatic Injury in Children
Authors: Eric Anthony Sribnick, MD, PhD, FAANS ; Josey Hensley, RN; Melissa Moore-Clingenpeel, PhD; Jennifer Muszynski, MD; Rajan Thakkar, MD; Mark Hall, MD (Columbus, OH)
A common complication of traumatic brain injury (TBI) is nosocomial infection, which may be due to immunosuppression following the injury. We hypothesized that critically ill pediatric trauma patients with TBI would demonstrate higher rates of nosocomial infection than those without TBI.
This is a retrospective case-control study. Patients under 18 years 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 non-accidental 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 PRISM III and PELOD-2 scores were determined. Patients were classified as having an 1) isolated TBI, 2) a traumatic injury without TBI, or 3) polytrauma with TBI.
203 patients were included in the analyses, and 27 patients developed a nosocomial infection. Patients with polytrauma with TBI demonstrated a significantly higher infection rate (30%) than patients with isolated TBI (6%) or traumatic injury without TBI (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.
In this single center, retrospective analysis of critically ill pediatric trauma patients, nosocomial infections were more frequently observed in patients admitted following polytrauma with TBI than in patients with isolated TBI or trauma without TBI.