175 Incidence, Risk Factors, and Outcomes of Infection Following Penetrating Traumatic Brain Injury: Propensity Score-Matched Analysis

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INTRODUCTION: Penetrating traumatic brain injury (pTBI) is a surgical emergency with increased mortality. Infection after pTBI remains a major concern. While antimicrobial prophylaxis is well studied, less is known about patient-level risk factors for infection. METHODS: The National Trauma Data Bank (2017–2019) was queried for pTBI cases. Of these, 184 patients who developed postoperative infection (surgical site infection, sepsis, or osteomyelitis) were propensity-matched to patients without infection based on demographics, Glasgow Coma Scale, and insurance type. Baseline comorbidities and hospital outcomes were compared using paired Student’s t-test and chi-square tests. Multivariable regression was used to assess factors associated with infection (p < 0.05). RESULTS: pTBI cohort had an average age of 35.59 ± 17.45 years and was predominantly male (83.6%). There were 184 patients in the infection group and 16,850 patients in the Non-Infection group. Baseline group comparisons showed the infection group had a significantly higher rate of hypertension and smoking (p<0.01 and p=0.03, respectively, and a higher rate of public insurance use (p<0.001), while the Non-Infection group had a higher rate of self-pay (p<0.001). Multivariate logistic regression showed that hypertension and smoking independently increased the risk of infection (Odds Ratio (OR) 3.63 [1.43-9.19], p<0.01; OR 2.68 [1.41-5.08], p<0.01, respectively). Infection was associated with a longer hospital stay (p<0.001) and a decreased risk of mortality (p<0.001). CONCLUSIONS: Hypertension and smoking independently predict infection after pTBI. Infections were associated with prolonged hospital stay but improved survival. This lower mortality may reflect survival through the initial traumatic insult, allowing time for infection to develop. Patients with these risk factors may benefit from closer monitoring and targeted prophylactic strategies.

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