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Published on: August 16, 2019
Pediatric traumatic brain injury: Resource utilization and outcomes at adult versus pediatric trauma centers
Ruth A Lewit1, Laura V Veras1, Mehmet Kocak2
1Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
Insights
Outcomes for pediatric traumatic brain injury (TBI) patients were similar across pediatric, adult, and combined trauma centers. This suggests current triage guidelines for children with TBI may not need adjustment based on hospital type.
Area of Science:
- Pediatric Trauma Surgery
- Neurotrauma Research
- Public Health Policy
Background:
- Traumatic brain injury (TBI) is a significant cause of death in pediatric trauma cases.
- Existing research suggests potential outcome disparities based on trauma center designation.
Purpose of the Study:
- To investigate if children with isolated TBI experience different outcomes at pediatric versus adult or combined trauma centers.
- To inform prehospital transport and triage guidelines for pediatric TBI patients.
Main Methods:
- Utilized the 2015 National Trauma Data Bank for children (≤16 years) with isolated TBI.
- Conducted univariable, multivariable, and Kaplan-Meier survival analyses.
- Collected and analyzed demographics and clinical outcomes, including in-hospital mortality and complications.
Main Results:
- 3,766 pediatric patients with isolated TBI were analyzed; 28% treated at pediatric, 51% at adult, and 21% at combined centers.
- Higher blood pressure and lower injury severity score correlated with reduced mortality.
- Increasing injury severity score was a significant predictor of higher mortality (OR 1.57).
- No significant survival differences were observed among the different trauma center types (P = .88).
Conclusions:
- Outcomes for pediatric isolated TBI are comparable across pediatric, adult, and combined trauma centers.
- Findings suggest current prehospital transport and triage strategies for pediatric TBI may be appropriate regardless of center designation.
Introduction:
Traumatic brain injury is the leading cause of trauma-related death in children. We hypothesized that children with isolated traumatic brain injury would experience differential outcomes when treated at pediatric versus adult or combined trauma centers.
Methods:
After institutional review board approval, the 2015 National Trauma Data Bank was queried for children up to age 16 years with isolated traumatic brain injury. Demographics and clinical outcomes were collected. Univariable and multivariable analyses were conducted to assess for predictors of in-hospital mortality and complications. Kaplan-Meier survival analysis was conducted.
Results:
A total of 3,766 children with isolated traumatic brain injury were identified; 1,060 (28%) were treated at pediatric trauma centers, 1,909 (51%) at adult trauma centers, and 797 (21%) at combined trauma centers. Subjects were 5 years old (median, interquartile range 1-12 years), 63% male, and 64% white. Higher blood pressure and lower injury severity score were associated with reduced mortality (P < .05). Increasing injury severity score was associated with higher mortality by multivariable logistic regression (odds ratio 1.57, P < .0001). There were no survival differences among hospital types (P = .88).
Conclusion:
Outcomes for children with isolated traumatic brain injury appear equal across different types of designated trauma centers. These findings may have implications for prehospital transport and triage guidelines.
