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Factors influencing admission among children with a traumatic brain injury
Melissa Lee McCarthy1, Tracey Serpi, Joseph A Kufera
1Departments of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. mmccarth@jhmi.edu
Insights
Pediatric traumatic brain injury (TBI) affects children across Maryland. Hospitalization for TBI varies significantly based on insurance, injury severity, and hospital type, highlighting disparities in care.
Area of Science:
- Pediatric Traumatology
- Public Health Epidemiology
- Healthcare Disparities
Background:
- Traumatic brain injury (TBI) is a significant public health concern in children.
- Understanding the epidemiology and factors influencing TBI care is crucial for improving outcomes.
Purpose of the Study:
- To describe the epidemiology of pediatric traumatic brain injury (TBI) in Maryland.
- To examine patient, injury, and hospital characteristics affecting TBI hospital admission.
Main Methods:
- Utilized statewide mortality, hospital discharge, and ambulatory care data for 1998.
- Analyzed TBI-related emergency department visits, hospitalizations, and deaths in children aged 0-19.
- Modeled inpatient admission based on patient, injury, and hospital factors.
Main Results:
- Overall pediatric TBI incidence was 670/100,000 in 1998.
- Uninsured children were less likely, and Medicaid recipients more likely, to be hospitalized compared to privately insured children.
- Associated injuries and presentation to trauma centers significantly increased hospitalization likelihood, with variations by income and hospital volume.
Conclusions:
- Significant disparities in TBI hospitalization rates exist among pediatric patient subgroups.
- Hospital characteristics and patient insurance status are key determinants of TBI admission for children.
- Further research is needed to address inequities in pediatric TBI care.
Objectives:
To describe the epidemiology of traumatic brain injury (TBI) among children in Maryland and to examine factors that influence hospital admission.
Methods:
Statewide mortality, hospital discharge, and ambulatory care data were used to identify all TBI-related emergency department (ED) visits, hospitalizations, and deaths that occurred in 1998 to children aged 0-19 years according to the Centers for Disease Control and Prevention's standard case definition and protocol. Inpatient admission was modeled as a function of patient, injury, and hospital characteristics.
Results:
The overall incidence of pediatric TBI (i.e., ED visits, hospitalizations, and deaths) in 1998 was 670/100,000. After controlling for injury severity and other factors, uninsured children were 40% less likely to be hospitalized (95% CI = 0.43 to 0.82) and children with Medicaid were 90% more likely to be hospitalized (95% CI = 1.42 to 2.54) than were those with private insurance. The presence of a major associated injury significantly influenced the likelihood of hospitalization, especially among children with a minor (OR = 8.8) to moderate (OR = 11.6) TBI. Children who presented to a trauma center hospital were significantly more likely to be hospitalized than children treated at a non-trauma center hospital, although this varied depending on income (OR = 1.8 for high versus low) and hospital volume (OR = 2.6 for a small hospital and OR = 29.0 for a large hospital).
Conclusions:
After adjusting for TBI severity and the presence of associated injuries, significant differences in hospitalization rates may exist among different patient subgroups and hospitals for children who sustain TBIs.
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