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Updated: Feb 20, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Severe traumatic brain injuries in children: Does the type of trauma center matter?
James M Bardes1, Elizabeth Benjamin1, Agustin Alvarez Escalante1
1Division of Trauma and Critical Care, University of Southern California Los Angeles, California, USA.
Insights
Pediatric patients with severe traumatic brain injury (TBI) treated at pediatric trauma centers (PTC) show better survival than those at adult trauma centers (ATC). Mixed trauma centers (MTC) also improve survival for TBI patients with moderate head injury (AIS 4).
Area of Science:
- Trauma Surgery
- Pediatric Neurosurgery
- Public Health
Background:
- Traumatic brain injury (TBI) is a leading cause of death in injured children.
- Outcomes for severe TBI in pediatric patients vary based on trauma center type: pediatric (PTC), adult (ATC), or mixed (MTC).
- The impact of trauma center designation on pediatric severe TBI outcomes remains unclear.
Purpose of the Study:
- To investigate the association between trauma center type and outcomes in pediatric patients with severe isolated TBI.
- To compare mortality rates and survival between PTC, ATC, and MTC for severe TBI.
- To identify if specific injury severities benefit from particular trauma center types.
Main Methods:
- Analysis of the National Trauma Data Bank (NTDB) from 2007-2014.
- Inclusion of level 1 trauma centers and pediatric patients (≤14 years) with severe isolated TBI (head Abbreviated Injury Scale [AIS] ≥3, extracranial AIS ≤2).
- Logistic regression analysis to compare outcomes across PTC, ATC, and MTC.
Main Results:
- A total of 10,402 patients were analyzed; 42.6% were treated at PTC, 38.9% at ATC, and 18.5% at MTC.
- Overall mortality was 3.2%, with PTC having the lowest (2.0%) and ATC the highest (4.5%).
- Treatment at ATC was linked to significantly higher mortality than PTC (OR 1.55, p=0.011). Patients with head AIS 4 treated at MTC showed significantly lower mortality (OR 0.163, p=0.002).
Conclusions:
- Pediatric patients with severe isolated TBI treated at PTC experience significantly better survival compared to those treated at ATC.
- No significant survival difference was observed between PTC and MTC for overall severe TBI.
- Patients with isolated TBI and a head AIS score of 4 demonstrated improved survival when treated at MTC compared to PTC.
Background:
Traumatic brain injury (TBI) is the leading cause of death among injured children. Depending on geographic location, and trauma resources, pediatric patients may be treated at pediatric (PTC), adult (ATC), or mixed trauma centers (MTC). The effect of the type of trauma center on outcomes in severe TBI is not known.
Methods:
NTDB study (2007-2014), level 1 trauma centers, patients ≤14years with severe isolated TBI (head AIS≥3 and extracranial AIS≤2). Demographic, clinical and injury characteristics were abstracted. Logistic regression was used to compare outcomes between the three types of trauma centers.
Results:
10,402 patients met inclusion criteria. 4430 (42.6%) were admitted in PTC, 4044 (38.9%) in ATC and 1928 (18.5%) in MTC. Overall, 39.9% of patients had head AIS 3, 55.5% had AIS 4 and 4.6% AIS 5. Mortality was 3.2% (2.0% in PTC, 4.5% in ATC and 3.3% in MTC). On logistic regression, treatment at ATC was associated with significantly higher mortality than PTC (OR 1.55, p=0.011). There was no significant difference between PTC and MTC (p=0.394). There was no significant difference in mortality between the 3 types of trauma centers in the subgroups of patients with head AIS 3 or 5. However, patients with head AIS 4 treated at MTC had significantly lower mortality (OR 0.163, 95% CI 0.053-0.501, p=0.002).
Conclusion:
Patients with isolated severe TBI treated at PTC have significantly better survival than patients treated at ATC, but not MTC. In the subgroup of patients with isolated TBI and a head AIS score of 4, patients treated at MTC have improved survival than those treated at PTC.
Level Of Evidence:
III.
