Aspiration pneumonia following severe traumatic brain injury; prevalence and risk factors for long-term mortality

Dysphagia and aspiration pneumonia are prevalent but infrequently studied complications following severe traumatic brain injury (TBI). Aspiration pneumonia is responsible for a significant number of long-term deaths in this population, however, the number of deaths attributed to aspiration pneumonia may be inaccurate. This multi-centre inception cohort (n = 2545) study of consecutive discharges from three metropolitan inpatient brain injury rehabilitation units aimed to 1) evaluate the prevalence of aspiration pneumonia, percutaneous endoscopic gastrostomy (PEG) insertion and dysphagia following TBI; 2) identify the number of deaths ascribed to aspiration pneumonia, and 3) characterise associated risk factors for long-term aspiration pneumonia related deaths compared to all other causes of death. In-hospital PEG insertion occurred in 18.4% of the sample, 2/3 of whom remained dysphagic at discharge. In-hospital aspiration pneumonia was recorded in 3.6% of the sample. Post-discharge, people with TBI were 79 times more likely to die from aspiration pneumonia than the general population. Risks were higher for subjects discharged to a nursing home, with severe ongoing functional disability, dysphagia at discharge, in those who had experienced in-hospital aspiration pneumonia or required PEG insertion. Early identification and risk management of dysphagia and aspiration pneumonia in TBI nursing home populations may maximise these individuals' quality and length of life.