The association of functional oral intake and pneumonia in patients with severe Traumatic Brain Injury

Abstract

Objective(s): This study investigates the incidence and onset time of pneumonia for patients with severe Traumatic Brain Injury (TBI) in the early phase of rehabilitation, and identifies parameters associated with the risk of pneumonia.

Design: Observational retrospective cohort study.

Setting: A subacute rehabilitation department, university hospital, Denmark.

Participants: One-hundred and seventy-three patients aged 16-65 years with severe TBI admitted over a 5-year period. Patients are transferred to the Brain Injury Unit (BIU) as soon as they ventilate spontaneously.

Intervention: None

Main Outcome Measure(s): Pneumonia.

Results: Twenty-seven percent (27%) of the patients admitted to the BIU were in treatment for pneumonia and 12% developed pneumonia during rehabilitation, all but one within 19 days of admission. Of these patients, 81% received nothing by mouth. Three factors identified patients at highest risk of pneumonia: Glasgow Coma score (GCS) <9 (one day after cessation of sedation); Ranchos Los Amigos scale (RLA) <3 (on admission); and no oral intake on admission. Having a tracheotomy tube and/or feeding tube was also associated with a higher occurrence of pneumonia.

Conclusions: Among patients with severe TBI, twenty-seven percent had pneumonia at transfer from the Intensive Care unit. Only 12% developed pneumonia during rehabilitation. Patients with low level of consciousness and patients with tracheotomy tube or feeding tube had a higher likelihood of pneumonia.