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Pediatric severe TBI in South America: Healthcare resource utilization before and during the COVID-19 pandemic
Janessa M Graves1,2,3, Silvia Lujan4, Julia L Velonjara3,5
1WWAMI Rural Health Research Center, Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America.
Insights
Pediatric severe traumatic brain injury (TBI) care remained consistent during the COVID-19 pandemic in South America. Clinicians successfully adapted, with no significant changes in intensive care unit (ICU) utilization or patient outcomes observed.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Global health disparities
Background:
- Traumatic brain injury (TBI) is a major cause of death and disability in children globally.
- Understanding healthcare utilization for severe pediatric TBI is vital for improving clinical practices and outcomes.
- Resource settings significantly impact TBI management and patient trajectories.
Purpose of the Study:
- To examine hospital services utilization for severe TBI in pediatric patients across South America.
- To compare healthcare utilization and outcomes during the COVID-19 pandemic versus the prepandemic period.
- To assess the adaptability of clinical teams in managing severe pediatric TBI during a global health crisis.
Main Methods:
- Secondary analysis of data from a randomized controlled trial on severe TBI clinical management guidelines.
- Inclusion of pediatric patients (<18 years) with severe TBI from 16 hospitals in Argentina, Chile, and Paraguay.
- Data collection on demographics, injury characteristics, clinical presentation, ICU utilization, surgical interventions, and imaging, analyzed across prepandemic and pandemic periods.
Main Results:
- 116 pediatric severe TBI patients were analyzed; 80 prepandemic and 36 during the pandemic.
- No significant differences were found in demographics, injury mechanisms, or discharge outcomes between the two periods.
- Vasopressor use and surgical interventions decreased during the pandemic, while other critical care measures remained stable. Intracranial pressure monitoring exceeded 50% throughout.
Conclusions:
- Clinicians demonstrated successful adaptation to managing severe pediatric TBI during the COVID-19 pandemic.
- No significant impact of the pandemic was detected on pediatric severe TBI intensive care unit (ICU) utilization or hospital discharge outcomes.
- Healthcare systems in South America maintained consistent care standards for severe pediatric TBI despite the pandemic's challenges.
Abstract:
Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality worldwide. Understanding healthcare utilization during hospitalization for severe TBI across varied resource settings is crucial for informing improvements in clinical practice, patient outcomes, and for reducing TBI burden. We examined hospital services utilization among children with severe TBI in South America. This secondary analysis of data collected during the baseline period of a randomized controlled trial implementing severe TBI clinical management guidelines identified pediatric patients (<18 years) with severe TBI across 16 hospitals in Argentina, Chile, and Paraguay between September 1, 2019 and July 13, 2020. Demographics, injury characteristics, clinical presentation, intensive care unit (ICU) utilization, surgical interventions, and imaging data were collected, and descriptive statistics were calculated. Utilization differences were examined across two time periods based on the COVID-19 pandemic: prepandemic (September 1, 2019-March 10, 2020) and during the pandemic (March 11-July 13, 2020) using Student's t-tests and chi-square tests. One-hundred and sixteen patients (median age: 6.5 years) with severe TBI enrolled during the study (n = 80 prepandemic and n = 36 during the pandemic) period. There were no differences in demographic characteristics, injury mechanism, or discharge outcomes between time periods. Vasopressor use was less common during the pandemic (63.8% vs. 33.3%, p < 0.01) as were surgeries (p = 0.05). Other measures, including nutrition, mechanical ventilation, and central venous pressure monitoring were stable over time. Intracranial pressure (ICP) monitoring remained above 50% throughout. We failed to detect a pandemic effect resulting in pediatric severe TBI ICU care or hospital discharge outcome changes. Clinicians adapted successfully.
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