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Published on: August 16, 2019
Variability in Standardized Mortality Rates Among Pediatric Traumatic Brain Injury Patients: A Comparative Analysis
Alice M Martino1, Jeffrey Santos1, Andreina Giron2
1Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA.
Insights
Pediatric traumatic brain injury (TBI) care varies significantly. A small percentage of trauma centers show notably better or worse mortality rates, highlighting opportunities for quality improvement in TBI patient outcomes.
Area of Science:
- Pediatric Traumatology
- Health Services Research
- Critical Care Medicine
Background:
- Traumatic brain injury (TBI) is a leading cause of death and disability in children.
- Significant variability exists in the care and outcomes of pediatric TBI patients.
- Standardized Mortality Ratios (SMRs) are used to compare center-specific mortality rates adjusted for patient complexity.
Purpose of the Study:
- To evaluate variations in SMRs among pediatric trauma centers for TBI.
- To identify centers with significantly different mortality rates compared to the national median.
- To provide a benchmark for assessing and improving pediatric TBI care quality.
Main Methods:
- Retrospective analysis of pediatric TBI patients (ages 1-18) from the National Trauma Data Bank (NTDB) (2017-2019).
- Calculation of center-specific SMRs with 95% confidence intervals to identify outliers.
- Risk adjustment for patient factors to ensure fair comparison of mortality rates.
Main Results:
- 316 centers and 10,598 patients were analyzed.
- Three centers (1.5%) demonstrated significantly lower mortality (SMR < 1), while three (1.5%) showed significantly higher mortality (SMR > 1).
- Centers with better outcomes had less neurosurgical intervention but more supplemental oxygen and VTE prophylaxis.
Conclusions:
- This study identified pediatric trauma centers with statistically significant variations in TBI patient mortality.
- These findings establish a benchmark for institutional quality improvement initiatives.
- Understanding these variations can guide best practices for pediatric TBI management.
Introduction:
Traumatic brain injury (TBI) causes significant morbidity and mortality in pediatric patients and care is highly variable. Standardized mortality ratio (SMR) summarizes the mortality rate of a specific center relative to the expected rates across all centers, adjusted for case-mix. This study aimed to evaluate variations in SMRs among pediatric trauma centers for TBI.
Methods:
Patients aged 1-18 diagnosed with TBI within the National Trauma Data Bank (NTDB) from 2017 to 2019 were included. Center-specific SMRs and 95% confidence intervals identified centers with mortality rates significantly better or worse than the median SMR for all centers.
Results:
316 centers with 10,598 patients were included. SMRs were risk-adjusted for patient risk factors. Unadjusted mortality ranged from 16.5 to 29.5%. Three centers (1.5%) had significantly better SMR (SMR <1) and three centers (1.5%) had significantly worse SMR (SMR >1). Significantly better centers had a lower proportion of neurosurgical intervention (2.4% vs. 11.8%, p < 0.001), a higher proportion of supplemental oxygen administration (93.7% vs. 83.5%, p = 0.004) and venous thromboembolism prophylaxis (53.2% vs. 40.6%, p < 0.001) compared to significantly worse centers.
Conclusions:
This study identified centers that have significantly higher and lower mortality rates for pediatric TBI patients relative to the overall median rate. These data provide a benchmark for pediatric TBI outcomes and institutional quality improvement.
Level Of Evidence:
Level III.
Type Of Study:
Retrospective Comparative Study.
