Incidence and risk factors of sepsis in patients with severe traumatic brain injury at Mulago National Referral Hospital : a prospective cohort study

Abstract

Background: Trauma is a major cause of death worldwide, with a mortality of 4,500,000 people per year. Globally, over 10 million people suffer traumatic brain injury. In Mulago National Referral Hospital, severe traumatic brain injury accounts for about 15.5% of all traumatic brain injury cases with a mortality rate of about 55%. Sepsis in traumatic brain injury is one of the commonest diagnosis in Mulago hospital intensive care unit. Early recognition and prevention of the occurrence of sepsis following severe traumatic brain injury can improve the patients’ morbidity and prevent mortality. Aim: To determine the incidence and factors associated with sepsis following severe traumatic brain injury among patients presenting at Mulago National Referral Hospital. Method: This was a prospective cohort study carried for a period of three months in Mulago National Referral Hospital. Severe traumatic brain injury patients were recruited and baseline clinical and demographic characteristics recorded. Patients were followed up for up to 14 days for the occurrence of sepsis. Data was entered using Excel, Microsoft 2018 and exported to standard statistical software (SPSS version 15.0, Chicago, IL) for analysis. A logistic regression model was used to assess for associated factors. At bivariate level, variables with a p-value less than 0.2 were considered for multivariate analysis. A final multivariate model was constructed and variables with a p-value of < 0.05% were considered statistically significant. Results: A total of 182 patients with severe traumatic brain injury met the inclusion criteria, but 25 died before enrollment and 05 declined to participate. 152 patients were enrolled. The mean (SD) age at enrolment was 31.3 (17.2) years and 122 (80.3%) were male. The cumulative incidence of sepsis in the severe traumatic brain injury patients was 5.3% over 14 days. Age (RR=1.02, p-value= 0.004), time between injury and admission (RR=1.01, p-value =0.001) and scalp wound contamination (RR=2.41, p-value=0.003) were found to be risk factors of sepsis in severe traumatic brain injury. Conclusion: The incidence of sepsis following severe traumatic brain injury is significant. Age, wound contamination and time between injury and admission were found to be risk factors of sepsis following severe traumatic brain injury. Recommendations: Patients who had long a duration between injury and admission, those with wound contamination and the older the patient is should be assessed regularly for sepsis; prevention efforts and early treatment should be employed.