Risk factors for intracranial infection in traumatic brain injury patients: a systematic review and meta-analysis.

PURPOSE: The meta-analysis was conducted to summarize the risk factors for intracranial infection in traumatic brain injury (TBI) patients. METHODS: PubMed, Web of Science, EMBASE, and the Cochrane Library were searched from inception to 29 June 2025. Study was assessed using the Newcastle-Ottawa Scale and GRADE. RevMan 5.4, Stata 18 were used for the data analyses and R software version 4.4.1 were used to visualize. RESULTS: 16 studies involving 100,255 patients with TBI were included, of which 8 studies involving 374,47 TBI patients who underwent neurosurgical intervention. In the overall TBI cohorts, the pooled incidence of intracranial infection was 13% (95% CI 7-21). Age, falls, postoperative glasgow coma scale (GCS), injury severity score (ISS), cerebrospinal fluid (CSF) leakage, open traumatic brain injury, multiple trauma, frontal bone fracture, skull base fracture, sphenoid fracture, external ventricular drainage (EVD) insertion, operation, intracranial pressure (ICP) monitoring were associated with intracranial infection. Among TBI patients undergoing neurosurgical intervention, the pooled incidence was 19% (95% CI 9-32). Preoperative GCS, posterior fossa surgery, EVD insertion, operation time ≥4 hours, sepsis and intraventricular hemorrhage (IVH) were associated with intracranial infection. CONCLUSION: These findings support risk assessment based on patient-specific profiles after TBI. This may help identify high-risk patients and guide postoperative surveillance.