Related Experiment Video
Updated: Feb 22, 2026
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Critical Care Resource Utilization and Outcomes of Children With Moderate Traumatic Brain Injury
Theerada Chandee1,2, Vivian H Lyons2,3, Monica S Vavilala1,2
1Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Insights
Moderate pediatric traumatic brain injury (TBI) care is resource-intensive, with over half of patients requiring critical care. Factors like lower Glasgow Coma Scale scores and higher Injury Severity Scores increase poor outcomes, necessitating improved triage and care for this vulnerable group.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Public health and injury prevention
Background:
- Moderate pediatric traumatic brain injury (TBI) represents a significant clinical challenge.
- Understanding admission patterns and resource utilization is crucial for optimizing care.
- Previous studies have not fully characterized critical care needs and outcomes in this population.
Purpose of the Study:
- To analyze admission trends and critical care resource utilization in pediatric patients with moderate TBI.
- To identify factors associated with poor outcomes in this patient cohort.
- To highlight the need for improved management strategies for moderate pediatric TBI.
Main Methods:
- Retrospective cohort study utilizing the National Trauma Data Bank (2007-2014).
- Inclusion criteria: children (<18 years) with moderate TBI (Glasgow Coma Scale score 9-13).
- Analysis of clinical characteristics, critical care resource use (ICU, mechanical ventilation, ICP monitoring), and discharge outcomes.
Main Results:
- Over 20,000 patient records were analyzed; 58.7% utilized critical care resources.
- Patients with lower Glasgow Coma Scale scores (9 vs. 13) showed increased critical care needs.
- Poor outcomes (death, hospice, SNF, LTAC) affected up to one-third of patients, with increased risk in older children, lower GCS, higher ISS, and polytrauma.
Conclusions:
- Moderate pediatric TBI frequently requires critical care, often in non-trauma centers.
- Significant risk factors for poor outcomes include older age, lower admission GCS, higher ISS, and polytrauma.
- Urgent optimization of triage, care, and outcomes is needed for this vulnerable pediatric population.
Objectives:
To characterize admission patterns, critical care resource utilization, and outcomes in moderate pediatric traumatic brain injury.
Design:
Retrospective cohort study.
Setting:
National Trauma Data Bank.
Patients:
Children under 18 years old with a diagnosis of moderate traumatic brain injury (admission Glasgow Coma Scale score of 9-13) in the National Trauma Data Bank between 2007 and 2014.
Measurement And Main Results:
We examined clinical characteristics, critical care resource utilization, and discharge outcomes. Poor outcomes were defined as discharge to hospice, skilled nursing facility, long-term acute care, or death. We examined 20,010 patient records. Patients were 9 years old (interquartile range, 2-15 yr), male (64%) with isolated traumatic brain injury (81%), Glasgow Coma Scale score of 12, head Abbreviated Injury Scale score of 3, and Injury Severity Score of 10. Majority (34%) were admitted to nontrauma hospitals. Critical care utilization was 58.7% including 11.5% mechanical ventilation and 3.2% intracranial pressure monitoring. Compared to patients with Glasgow Coma Scale score of 13, admission Glasgow Coma Scale score of 9 was associated with greater critical care resource utilization, such as ICU admission (72% vs 50%), intracranial pressure monitoring (7% vs 1.8%), mechanical ventilation (21% vs 6%), and intracranial surgery (10% vs 5%). Most patients (70%) were discharged to home, but up to one third had poor outcomes. Older age group had a higher risk of poor outcomes (10-14 yr; adjusted relative risk, 1.32; 95% CI, 1.13-1.54; 15-17 yr; adjusted relative risk, 2.39; 95% CI, 2.12-2.70). Poor outcomes occurred with lower Glasgow Coma Scale (Glasgow Coma Scale score of 9 vs Glasgow Coma Scale score of 13: adjusted relative risk, 2.89; 95% CI, 2.47-3.38), higher Injury Severity Score (Injury Severity Score of ≥ 16 vs Injury Severity Score of < 9: adjusted relative risk, 8.10; 95% CI 6.27-10.45), and polytrauma (adjusted relative risk, 1.40; 95% CI, 1.22-1.61).
Conclusions:
Critical care resources are used in more than half of all moderate pediatric traumatic brain injury, and many receive care at nontrauma hospitals. Up to one third of moderate pediatric traumatic brain injury have poor outcomes, risk factors for which include age greater than 10 years, lower admission Glasgow Coma Scale, higher Injury Severity Score, and polytrauma. There is urgent need to optimize triage, care, and outcomes in this vulnerable population.
