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Hospitalizations for critically ill children with traumatic brain injuries: a longitudinal analysis
John M Tilford1, Mary E Aitken, K J S Anand
1Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR 72202-3591, USA. tilfordmickj@uams.edu
Insights
Improved treatment for pediatric traumatic brain injury (TBI) has saved thousands of lives, reducing mortality rates. However, disparities in outcomes persist for uninsured children, highlighting the need for equitable care.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Health services research
Background:
- Traumatic brain injury (TBI) is a significant cause of mortality and morbidity in children.
- Understanding trends in TBI management and outcomes is crucial for improving pediatric care.
Purpose of the Study:
- To examine the incidence, procedural utilization, and outcomes for critically ill children with TBI from 1988-1999.
- To assess the benefits of evolving treatment strategies for pediatric TBI.
Main Methods:
- Retrospective analysis of hospital discharge data from the Nationwide Inpatient Sample (NIS) covering U.S. acute care hospitals.
- Inclusion of children aged 0-21 with TBI diagnosis and procedures like endotracheal intubation or mechanical ventilation.
- Evaluation of intracranial pressure monitoring and surgical interventions as indicators of treatment aggressiveness.
Main Results:
- Over 12 years, mortality rates for pediatric TBI decreased by 8%, while intracranial pressure monitoring use increased by 11%.
- More aggressive TBI management correlated with improved hospital outcomes.
- Lack of insurance was linked to significantly worse outcomes, with an estimated 1,418 deaths due to increased mortality risk in uninsured children.
Conclusions:
- Aggressive management of pediatric TBI has demonstrably reduced mortality and saved lives.
- Addressing healthcare disparities for uninsured children is essential to further decrease TBI-related deaths and improve survival rates.
Objective:
This study examines the incidence, utilization of procedures, and outcomes for critically ill children hospitalized with traumatic brain injury over the period 1988-1999 to describe the benefits of improved treatment.
Design:
Retrospective analysis of hospital discharges was conducted using data from the Health Care Cost and Utilization Project Nationwide Inpatient Sample that approximates a 20% sample of U.S. acute care hospitals.
Setting:
Hospital inpatient stays from all types of U.S. community hospitals.
Participants:
The study sample included all children aged 0-21 with a primary or secondary ICD-9-CM diagnosis code for traumatic brain injury and a procedure code for either endotracheal intubation or mechanical ventilation.
Interventions:
None.
Measurements And Main Results:
Deaths occurring during hospitalization were used to calculate mortality rates. Use of intracranial pressure monitoring and surgical openings of the skull were investigated as markers for the aggressiveness of treatment. Patients were further classified by insurance status, household income, and hospital characteristics. Over the 12-yr study period, mortality rates decreased 8 percentage points whereas utilization of intracranial pressure monitoring increased by 11 percentage points. The trend toward more aggressive management of traumatic brain injury corresponded with improved hospital outcomes over time. Lack of insurance was associated with vastly worse outcomes. An estimated 6,437 children survived their traumatic brain injury hospitalization because of improved treatment, and 1,418 children died because of increased mortality risk associated with being uninsured. Improved treatment was valued at approximately dollar 17 billion, whereas acute care hospitalization costs increased by dollar 1.5 billion (in constant 2000 dollars). Increased mortality in uninsured children was associated with a dollar 3.76 billion loss in economic benefits.
Conclusions:
More aggressive management of pediatric traumatic brain injury appears to have contributed to reduced mortality rates over time and saved thousands of lives. Additional lives could be saved if mortality rates could be equalized between insured and uninsured children.
