The Repercussions of Healthcare-Associated Infections on Patients with Traumatic Brain Injuries: A Four-Years Study on Forensic Autopsies in Timiș County, Romania

Background/Objectives: When a patient dies and a complex pathology is identified, it can be difficult to ascertain the cause of death and the contribution of each ailment to the dying process. Patients with traumatic brain injuries often represent the best hosts for healthcare-associated infections, especially pneumonia or bronchopneumonia. Additionally, some of these ones also have pre-existing chronic diseases, which can influence their medical evolution. Therefore, many factors need to be carefully analyzed by the forensic doctor when establishing the cause of death. The purpose of this study is to demonstrate the crucial role a forensic autopsy plays in accurately identifying the cause of death and diagnosing all of a patient's ailments, particularly in cases involving nosocomial infections, while emphasizing the significant number of cases where healthcare-associated infections can lead to mortality. Methods: We conducted a retrospective analysis that included cases with cranial-cerebral traumas, pre-existing chronic diseases, and hospital-acquired infections that were autopsied at the Forensic Medicine Institute in Timișoara between January 1, 2018, and December 31, 2021. We studied the autopsy reports and the medical documentation of the patients. Results: Our research indicates that patients with traumatic brain injuries and non-traumatic conditions face a considerable risk of acquiring healthcare-associated infections, especially pneumonia or bronchopneumonia, even with adequate medical treatment. A significant part of these infectious issues remains unrecognized while hospitalization; however, autopsy can elucidate them. Conclusions: This study demonstrates a high prevalence of healthcare-associated infections in patients with brain injuries, as well as how these infections can alter the progression of traumatic disorders and their mortality rate.