Reduced hospitalisations for paediatric mild traumatic brain injury: a nationwide observational study

Area of Science:

• Pediatric Emergency Medicine
• Neurotrauma Research
• Public Health Surveillance

Background:

• Traumatic brain injury (TBI) is a significant concern in childhood, with mild TBI (mTBI) being the most common form.
• Germany exhibits notably high hospitalization rates for pediatric TBI, potentially indicating over-admission for milder cases.
• Understanding hospitalization trends and variability is crucial for optimizing pediatric TBI care.

Purpose of the Study:

• To analyze trends in TBI-related hospitalizations for patients under 18 years old in Germany from 2014 to 2020.
• To investigate the variability in TBI hospitalization rates across different pediatric emergency departments (EDs).

Main Methods:

• A retrospective observational study utilizing the German Hospital Dataset (GHD).
• Cases were identified using ICD-10 codes and severity was assessed using the Abbreviated Injury Scale (AIS) for head injuries.
• Data from 18 participating pediatric EDs were analyzed to compare inpatient vs. outpatient management proportions.

Main Results:

• A total of 618,577 TBI cases were analyzed, with annual hospitalizations decreasing from 91,299 in 2014-2019 to 70,783 in 2020.
• Standardized morbidity ratios (SMRs) for all-cause and mTBI admissions significantly decreased in 2020 compared to the reference period.
• Hospitalization rates varied widely across EDs, ranging from 19.1% to 93.0% (median 75.0%).

Conclusions:

• The disproportionate decline in mTBI hospitalizations during the COVID-19 pandemic suggests a potential for increased outpatient management of mild TBI cases.
• Variability in hospitalization practices highlights opportunities for standardizing care and improving resource allocation in pediatric TBI management.