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Variation in pediatric traumatic brain injury outcomes in the United States
Nathaniel H Greene1, Mary A Kernic2, Monica S Vavilala3
1Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA.
Insights
Pediatric traumatic brain injury (TBI) outcomes vary significantly by state. Discharge to rehabilitation and inpatient mortality rates show considerable differences, highlighting a need for standardized care across the United States.
Area of Science:
- Pediatric Traumatic Brain Injury Research
- Healthcare Outcomes Analysis
- Public Health Policy
Background:
- Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in children.
- Variations in healthcare practices and resource availability may influence TBI outcomes.
- Understanding state-level disparities in pediatric TBI care is crucial for improving patient management.
Purpose of the Study:
- To quantify the variation in outcomes for pediatric patients hospitalized with TBI across different US states.
- To examine state-specific differences in discharge to rehabilitation and inpatient mortality rates following TBI.
Main Methods:
- Retrospective cohort study utilizing data from the Healthcare Cost and Utilization Project (HCUP).
- Inclusion of pediatric patients (age ≤ 19 years) hospitalized for TBI in the US from 2001 to 2010.
- Analysis focused on the proportion of alive discharges to inpatient rehabilitation and inpatient mortality.
Main Results:
- Significant state-level variation was observed in the relative risk of discharge to inpatient rehabilitation (up to 3-fold difference).
- Inpatient mortality rates also varied significantly by state (nearly 2-fold difference).
- Eliminating observed outcome variation could lead to approximately 1981 additional pediatric TBI patients being discharged to inpatient rehabilitation annually.
Conclusions:
- Substantial interstate variation exists in pediatric TBI outcomes, including rehabilitation discharge and mortality.
- Further research is needed to identify the causes of these disparities and their impact on patient outcomes.
- Standardizing TBI treatment protocols across the United States is recommended to reduce outcome variability.
Objective:
To ascertain the degree of variation, by state of hospitalization, in outcomes associated with traumatic brain injury (TBI) in a pediatric population.
Design:
A retrospective cohort study of pediatric patients admitted to a hospital with a TBI.
Setting:
Hospitals from states in the United States that voluntarily participate in the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project.
Participants:
Pediatric (age ≤ 19 y) patients hospitalized for TBI (N=71,476) in the United States during 2001, 2004, 2007, and 2010.
Interventions:
None.
Main Outcome Measures:
Primary outcome was proportion of patients discharged to rehabilitation after an acute care hospitalization among alive discharges. The secondary outcome was inpatient mortality.
Results:
The relative risk of discharge to inpatient rehabilitation varied by as much as 3-fold among the states, and the relative risk of inpatient mortality varied by as much as nearly 2-fold. In the United States, approximately 1981 patients could be discharged to inpatient rehabilitation care if the observed variation in outcomes was eliminated.
Conclusions:
There was significant variation between states in both rehabilitation discharge and inpatient mortality after adjusting for variables known to affect each outcome. Future efforts should be focused on identifying the cause of this state-to-state variation, its relationship to patient outcome, and standardizing treatment across the United States.
