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Epidemiology and centralization of pediatric traumatic brain injury care in Lombardy, Italy: An 11-year regional
Floriana Ferrari1, Rita Campi2, Stefano Finazzi3
1Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care Medicine, ASST Papa Giovanni XXIII, Piazza OMS, 1, Bergamo, 24127, Italy. floriana.ferrari@gmail.com.
Insights
Pediatric traumatic brain injury (TBI) emergency visits and hospitalizations declined over 11 years. However, intensive care unit (ICU) cases became more concentrated at a central referral center, reflecting trauma system evolution.
Area of Science:
- Pediatric Traumatology
- Public Health
- Health Services Research
Background:
- Pediatric traumatic brain injury (TBI) is a significant cause of emergency department visits and hospitalizations in children.
- Specialized pediatric trauma systems and referral to high-volume centers are recommended for managing severe pediatric TBI.
Purpose of the Study:
- To analyze the epidemiology and temporal trends of pediatric TBI in Lombardy, Italy.
- To evaluate centralization patterns within the regional hub-and-spoke trauma network for pediatric TBI.
- To assess changes in emergency department visits, hospital admissions, and ICU admissions over an 11-year period.
Main Methods:
- Retrospective, population-based study using regional administrative healthcare databases.
- Inclusion of all pediatric (<18 years) TBI cases presenting to emergency departments in Lombardy from 2012 to 2022.
- Analysis of temporal trends using standardized rates and regression models, and assessment of ICU referral patterns.
Main Results:
- A total of 143,961 emergency department visits and 14,223 hospital admissions for pediatric TBI were recorded.
- Significant declines were observed in emergency department visit rates (≈1% annually) and hospital admission rates (≈4% annually).
- No significant temporal trend in intensive care unit (ICU) admissions was found, but the proportion of ICU cases managed at the regional referral center increased progressively.
Conclusions:
- Recorded emergency department visits and hospital admissions for pediatric TBI have decreased.
- Pediatric TBI cases requiring intensive care are increasingly managed at a high-volume referral center.
- These trends align with the development and evolution of a structured regional hub-and-spoke trauma system.
Abstract:
Pediatric traumatic brain injury (TBI) is a major public health concern requiring coordinated management within an organized trauma system. This study aimed to analyze the epidemiology and temporal trends of pediatric TBI in Lombardy (Italy) and to evaluate centralization patterns within the regional hub-and-spoke trauma network. We conducted a retrospective, population-based study using regional administrative healthcare databases. All healthcare episodes of children (< 18 years) with a diagnosis of TBI residing in Lombardy (Italy) who presented to emergency departments (EDs) between January 2012 and December 2022 were included. ED visits, hospital admissions, and intensive care unit (ICU) admissions were analyzed. Temporal trends in ED visits, hospital admissions, and ICU admissions were evaluated using standardized rates and regression models. Centralization was assessed through temporal changes in ICU referral patterns within the regional trauma network. A total of 143,961 ED visits and 14,223 hospital admissions for pediatric TBI were recorded. ED visit rates declined significantly over time (adjusted annual reduction ≈1%), while hospital admission rates also declined significantly (adjusted annual reduction ≈4%). In contrast, no significant temporal trend was observed for ICU admissions after multivariable adjustment. The proportion of ICU admissions managed at the designated regional referral center increased progressively over time.
Conclusion:
This population-based study identified declining recorded ED visits and hospital admissions for pediatric TBI, alongside increasing concentration of ICU-managed pediatric TBI cases at a high-volume referral center within a structured trauma system. These findings are consistent with the evolution of the regional hub-and-spoke trauma system.
What Is Known:
• Pediatric traumatic brain injury (TBI) is a major cause of emergency department visits and trauma-related hospitalizations in children. • Specialized pediatric trauma systems and referral to high-volume centers are recommended for severe pediatric TBI management.
What Is New:
• This population-based study provides an 11-year assessment of pediatric TBI epidemiology and temporal trends across an entire regional trauma network. • Over time, pediatric TBI cases requiring intensive care were increasingly managed at the regional referral center, consistent with the evolution of a regional hub-and-spoke trauma system.
