Outcomes of pediatric severe traumatic brain injury patients treated in adult trauma centers with and without added qualifications in pediatrics — United States, 2009

Abstract

Background: Pediatric traumatic brain injury (TBI) is an important public health problem and little is known about site of care and outcomes of children with severe TBI. Across the country, most injured children are treated in adult trauma centers (ATCs). Recent literature suggests that ATCs with added qualifications in pediatrics (ATC-AQs) can have improved outcomes for pediatric trauma patients overall. This study characterizes the population of pediatric severe TBI patients treated at ATCs and investigates the effect of treatment at ATC-AQs versus ATCs on mortality. Methods: Using the 2009 National Trauma Data Bank, pediatric (age 0–17 years old) severe TBI (head Abbreviated Injury Scale score ≥3) patient visits at level I and II ATCs and ATC-AQs were analyzed for patient and hospital characteristics. The primary outcome was in-patient mortality. Multivariate analysis was performed on propensity score weighted populations to investigate effect of treatment at ATC-AQs versus ATCs on survival. Results: A total of 7,057 pediatric severe TBI patient visits in 398 level I and II trauma centers were observed, with 3,496 (49.5%) at ATC-AQs and 3,561 (50.5%) at ATCs. The mortality rate was 8.6% at ATC-AQs versus 10.3% at ATCs (p =0.0144). After adjusting for differences in case mix, patient, and hospital characteristics, mortality was not significantly different for patients treated in ATC-AQs versus ATCs (aOR = 0.896, 95% CI = 0.629–1.277). Mortality was significantly associated with age, length of hospital stay, firearm injury, GCS score, and head AIS (p <0.0001). Higher mortality odds were also associated with being uninsured (aOR = 2.102, 95% CI = 1.159–3.813), and the presence of additional non-TBI severe injuries (aOR = 1.936 95% CI = 1.175-3.188). Conclusions: After defining comparable populations, this study demonstrated no significant difference in mortality for pediatric severe TBI patients treated at ATC-AQs versus ATCs. Being younger, uninsured, and having severe injuries was associated with increased mortality. This study is limited by the exclusion of transferred patients and potentially underestimates differences in outcomes. Further research is needed to clarify the role of ATC additional pediatric qualifications in the treatment of severe TBI.