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Published on: January 20, 2023
Revisits, readmissions, and outcomes for pediatric traumatic brain injury in California, 2005-2014
Renee Y Hsia1,2, Rebekah C Mannix3,4, Joanna Guo1
1Department of Emergency Medicine, University of California, San Francisco, California, United States of America.
Insights
Pediatric traumatic brain injury (TBI) patients have higher rates of emergency department revisits and hospital readmissions within a year compared to other trauma patients. Improved outpatient monitoring is crucial for better pediatric TBI outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Public Health
Background:
- Long-term outcomes after pediatric traumatic brain injury (TBI) are not well understood.
- Characterizing emergency department (ED) revisits, hospital readmissions, and mortality is essential for pediatric TBI care.
Purpose of the Study:
- To evaluate 1-year ED visit outcomes for pediatric TBI patients.
- To compare outcomes between pediatric TBI patients and a referent group of non-TBI trauma patients.
Main Methods:
- Longitudinal, retrospective study of pediatric trauma patients in California (2005-2014).
- Comparison of ED visits, dispositions, revisits, readmissions, and mortality between TBI and Other Trauma groups.
- Inclusion of 208,222 pediatric TBI patients and 1,314,064 Other Trauma patients.
Main Results:
- Population-adjusted TBI ED visits increased 5.6%, while Other Trauma visits decreased 40.7%.
- A significantly higher proportion of TBI patients revisited the ED (33.4% vs. 3.0%) and were readmitted (0.9% vs. 0.04%) within one year.
- Most patients were discharged on their initial visit (93.2% TBI vs. 96.5% Other Trauma).
Conclusions:
- The health burden within one year post-pediatric TBI is substantial and exceeds that of non-TBI trauma.
- Outpatient strategies are needed to monitor short- and longer-term sequelae after pediatric TBI.
- Improved monitoring can enhance patient outcomes, reduce family burden, and optimize healthcare resource allocation.
Abstract:
Long-term outcomes related to emergency department revisit, hospital readmission, and all-cause mortality, have not been well characterized across the spectrum of pediatric traumatic brain injury (TBI). We evaluated emergency department visit outcomes up to 1 year after pediatric TBI, in comparison to a referent group of trauma patients without TBI. We performed a longitudinal, retrospective study of all pediatric trauma patients who presented to emergency departments and hospitals in California from 2005 to 2014. We compared emergency department visits, dispositions, revisits, readmissions, and mortality in pediatric trauma patients with a TBI diagnosis to those without TBI (Other Trauma patients). We identified 208,222 pediatric patients with an index diagnosis of TBI and 1,314,064 patients with an index diagnosis of Other Trauma. Population growth adjusted TBI visits increased by 5.6% while those for Other Trauma decreased by 40.7%. The majority of patients were discharged from the emergency department on their first visit (93.2% for traumatic brain injury vs. 96.5% for Other Trauma). A greater proportion of TBI patients revisited the emergency department (33.4% vs. 3.0%) or were readmitted to the hospital (0.9% vs. 0.04%) at least once within a year of discharge. The health burden within a year after a pediatric TBI visit is considerable and is greater than that of non-TBI trauma. These data suggest that outpatient strategies to monitor for short-term and longer-term sequelae after pediatric TBI are needed to improve patient outcomes, lessen the burden on families, and more appropriately allocate resources in the healthcare system.
