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Pediatric Head Injury in the Delaware Trauma System: Toward Improved Calibration of Severity and Resource Utilization

Joseph Piatt, Diane Hochstuhl, Stephen Murphy

    Delaware Medical Journal
    |June 13, 2018
    PubMed

    Insights

    The opening of a pediatric trauma center correlated with an increase in recorded mild traumatic brain injuries (TBIs) and non-substantial admissions. This suggests a need for guidelines in managing less severe pediatric head injuries.

    Area of Science:

    • Trauma Systems Research
    • Pediatric Traumatic Brain Injury (TBI)

    Background:

    • The impact of trauma systems on the care of less severely injured patients remains under-researched.
    • Understanding how trauma system integration affects pediatric TBI care is crucial.

    Purpose of the Study:

    • To investigate the longitudinal impact of a pediatric trauma center's integration into a regional system on pediatric TBI care.
    • To analyze trends in mild TBI and non-substantial admissions following the establishment of a dedicated pediatric trauma center.

    Main Methods:

    • Utilized registry data from the Delaware Trauma System (2000-2014).
    • Included pediatric patients (<18 years) with head injuries (ICD9 coding).
    • Classified admissions as 'substantial' or 'non-substantial' and hypothesized increased registrations post-center opening.

    Main Results:

    • Mild TBI registrations increased from 85.2% to 89.6% post-center opening (OR 1.49, p<0.0001).
    • Non-substantial admissions rose from 41.7% to 47.3% (OR 1.25, p<0.0001).
    • Similar upward trends were observed in inter-hospital transports.

    Conclusions:

    • A suggestive step-wise increase in mild TBI and non-substantial admissions coincided with the pediatric trauma center's opening.
    • Guidelines are necessary for managing minor pediatric head injuries at the appropriate care level.
    Abstract

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