Related Experiment Video
Updated: May 14, 2026
Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
Triage of children with moderate and severe traumatic brain injury to trauma centers
Mary A Kernic1, Frederick P Rivara, Douglas F Zatzick
1Department of Epidemiology, University of Washington, Seattl, Washington, USA.
Insights
Nearly 84% of pediatric traumatic brain injuries (TBI) receive care at trauma centers. Factors like polytrauma and severe TBI increase the likelihood of trauma center treatment for children.
Area of Science:
- Pediatric Traumatology
- Neuroscience
- Health Services Research
Background:
- Outcomes in pediatric traumatic brain injury (TBI) depend on pre-injury factors and treatment location.
- Trauma centers may offer superior care compared to non-trauma centers for moderate to severe TBI.
Purpose of the Study:
- To determine the proportion of children with moderate to severe TBI treated at trauma centers.
- To identify factors associated with receiving care at adult (ATC), pediatric (PTC), or combined adult/pediatric trauma centers (APTC) versus non-trauma centers (NTC).
Main Methods:
- Utilized the Kids' Inpatient Database for a nationally representative sample of pediatric TBI hospitalizations.
- Included patients aged 0-17 with TBI and a head Abbreviated Injury Scale score ≥3.
- Employed multinomial logistic regression to analyze factors predicting facility type.
Main Results:
- 16.7% of pediatric TBI patients received care at NTCs.
- 83.3% were treated at Level I or II trauma centers (44.2% ATC, 17.9% PTC, 21.2% APTC).
- Receipt of trauma center care was linked to patient age and polytrauma.
Conclusions:
- Approximately 84% of pediatric moderate to severe TBI cases are managed at Level I or II trauma centers.
- Children with polytrauma and more severe TBI are more likely to be treated at trauma centers.
Abstract:
Outcomes after pediatric traumatic brain injury (TBI) are related to pre-treatment factors including age, injury severity, and mechanism of injury, and may be positively affected by treatment at trauma centers relative to non-trauma centers. This study estimated the proportion of children with moderate to severe TBI who receive care at trauma centers, and examined factors associated with receipt of care at adult (ATC), pediatric (PTC), and adult/pediatric trauma centers (APTC), compared with care at non-trauma centers (NTC) using a nationally representative database. The Kids' Inpatient Database was used to identify hospitalizations for moderate to severe pediatric TBI. Pediatric inpatients ages 0 to 17 years with at least one diagnosis of TBI and a maximum head Abbreviated Injury Scale score of ≥3 were studied. Multinomial logistic regression was performed to examine factors predictive of the level and type of facility where care was received. A total of 16.7% of patients were hospitalized at NTC, 44.2% at Level I or II ATC, 17.9% at Level I or II PTC, and 21.2% at Level I or II APTC. Multiple regression analyses showed receipt of care at a trauma center was associated with age and polytrauma. We concluded that almost 84% of children with moderate to severe TBI currently receive care at a Level I or Level II trauma center. Children with trauma to multiple body regions in addition to more severe TBI are more likely to receive care a trauma center relative to a NTC.
