title: Pneumonia in patients with severe head injury: incidence, risk factors, and outcomes.
abstract: OBJECTIVE
  The reported incidence of hospital-acquired bacterial pneumonia in critically ill trauma patients varies from as low as 4% to as high as 87%, with fatality rates varying from 6% to 59%. Clinical studies have identified the risk factors for pneumonia. The authors undertook this retrospective study to evaluate the incidence, risk factors, and outcomes of hospital-acquired bacterial pneumonia in a group of patients with severe head injuries.
  
  
  METHODS
  This was a retrospective review of consecutive adult patients admitted to the neurosurgical ICU in the authors' hospital because of severe head injury (Glasgow Coma Scale scores ≤ 8) between January 2008 and December 2010.
  
  
  RESULTS
  During the study period, 290 patients were admitted to the neurosurgical ICU. Multivariate Cox regression analysis showed that age (HR 1.01, 95% CI 1.001-1.02), nasogastric tube insertion (HR 4.56, 95% CI 1.11-18.64), and hemiplegia or hemiparesis (HR 3.79, 95% CI 2.01-7.17) were significantly associated with the development of pneumonia.
  
  
  CONCLUSIONS
  The authors identified 3 risk factors (age, nasogastric tube insertion, and hemiplegia or hemiparesis) associated with the development of pneumonia in patients with severe head injury. This finding constituted the basis for developing a simple screening tool that can be used to assess the risk of occurrence of pneumonia in such patients.
authors.affiliation: Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung 824, Taiwan.
authors.forename: Kuo-Wei
authors.initials: KW
authors.lastname: Wang
authors.forename: Han-Jung
authors.initials: HJ
authors.lastname: Chen
authors.forename: Kang
authors.initials: K
authors.lastname: Lu
authors.forename: Po-Chou
authors.initials: PC
authors.lastname: Liliang
authors.forename: Chun-Kai
authors.initials: CK
authors.lastname: Huang
authors.forename: Pi-Lien
authors.initials: PL
authors.lastname: Tang
authors.forename: Yu-Duan
authors.initials: YD
authors.lastname: Tsai
authors.forename: Hao-Kuang
authors.initials: HK
authors.lastname: Wang
authors.forename: Cheng-Loong
authors.initials: CL
authors.lastname: Liang
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006259:Craniocerebral Trauma / Q000401:mortality*; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D023261:Glasgow Outcome Scale; D006429:Hemiplegia / Q000401:mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007441:Intubation, Gastrointestinal / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000401:mortality; D018410:Pneumonia, Bacterial / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors