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Facility characteristics and inhospital pediatric mortality after severe traumatic brain injury
Brianna Mills1, Ali Rowhani-Rahbar1, Joseph A Simonetti2
11Department of Epidemiology, University of Washington, Seattle, Washington.
Insights
Pediatric severe traumatic brain injury (TBI) outcomes vary by hospital location. Patients in the Midwest and South regions had higher in-hospital mortality rates, highlighting regional disparities in pediatric TBI care.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Health Services Research
Background:
- Over 500,000 children experience traumatic brain injuries (TBIs) annually.
- Significant variations in in-hospital mortality rates following pediatric TBI have been previously documented.
- The influence of facility-level characteristics on pediatric TBI outcomes requires further investigation.
Purpose of the Study:
- To identify facility-level characteristics associated with 30-day in-hospital mortality in pediatric severe TBI patients.
- To determine if hospital characteristics impact mortality independently of patient-level factors.
- To explore regional variations in outcomes for severe pediatric TBI.
Main Methods:
- Utilized data from the National Trauma Data Bank (2009-2012).
- Included 6707 pediatric patients with severe TBI across 391 facilities.
- Employed Poisson regression to analyze 30-day in-hospital mortality, controlling for patient and facility characteristics.
Main Results:
- Patients treated in facilities in the Midwest (RR=1.42) and South (RR=1.39) regions exhibited higher 30-day in-hospital mortality compared to the Northeast.
- No other investigated facility-level characteristics (trauma certification, teaching status, size, nonprofit status, pediatric trauma responsibility) were significant.
- This study represents one of the largest national investigations into regional variations in pediatric severe TBI mortality.
Conclusions:
- Regional disparities exist in 30-day in-hospital mortality following severe pediatric TBI.
- Facility location (Midwest and South) is independently associated with increased mortality risk.
- Further research is necessary to understand and address the factors contributing to these regional variations in pediatric TBI care.
Abstract:
More than 500,000 children sustain a traumatic brain injury (TBI) each year. Previous studies have described significant variation in inhospital mortality after pediatric TBI. The aim of this study was to identify facility-level characteristics independently associated with 30-day inhospital mortality after pediatric severe TBI. We hypothesized that, even after accounting for patient-level characteristics associated with mortality, the characteristics of facilities where patients received care would be associated with inhospital mortality. Using data from the National Trauma Data Bank from 2009-2012, we identified a cohort of 6707 pediatric patients hospitalized with severe TBI in 391 facilities and investigated their risk of 30-day inhospital mortality. Pre-specified facility-level characteristics (trauma certification level, teaching status, census region, facility size, nonprofit status, and responsibility for pediatric trauma care) were added to a Poisson regression model that accounted for patient-level characteristics associated with mortality. In multivariable analyses, patients treated in facilities located in the Midwest (risk ratio [RR]=1.42; 95% confidence interval [CI] 1.12-1.81) and South (RR=1.39; 95% CI: 1.12-1.72) regions had higher likelihoods of 30-day inhospital mortality compared with patients treated in the Northeast. Other facility-level characteristics were not found to be significant. To our knowledge, this is one of the largest investigations to identify regional variation in inhospital mortality after pediatric severe TBI in a national sample after accounting for individual and other facility-level characteristics. Further investigations to help explain this variation are needed to inform evidence-based decision-making for pediatric severe TBI care across different settings.
