Hospitalizations for critically ill children with traumatic brain injuries: A longitudinal analysis*

Tilford, John M.; Aitken, Mary E.; Anand, K.J.S.; Green, Jerril W.; Goodman, Allen C.; Parker, James G.; Killingsworth, Jeffrey B.; Fiser, Debra H.; Adelson, P. David

doi:10.1097/01.ccm.0000171839.65687.f5

Cited by 61 publications

(37 citation statements)

References 37 publications

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“…That the study group so defined was "severe" is supported by the overall mortality rate of 24%, which is comparable to mortality rates for severe TBI among children defined by GCS or AIS scores in contemporary case series and prospective trials. 2,9,11,17,24,25,34,35,39,40,43,44,46,47 Nevertheless, the rate of neurosurgical procedures in the current study group (46.8%) was unexpectedly low. Even among admissions lasting 2 days or longer and ending in death, the rate of neurosurgical procedures was only 67.3%.…”

Section: The Missing Icp Monitorsmentioning

confidence: 76%

“…The current study confirmed the remarkably high mortality rate for admissions designated "self-pay," and this adverse effect of disadvantaged individual economic status persisted after lumping the category with Medicaid. 3,6,20,36,46 The association of higher mortality rates for trauma in the uninsured has been observed among adults as well. 3,18,42 The current study highlights the importance of community economic status, as reflected in the median income of home ZIP code.…”

Section: Mortality Ratesmentioning

confidence: 92%

“…Previous investigators have assumed that this designation signified urgent transfer to centers with specialized care not available at the admitting facility and therefore excluded such admissions from further analysis to avoid double counting. 6,46 Among severe TBI admissions as defined above, however, admissions ending in transfer to a short-term hospital had a longer LOS than admissions ending in discharge home, even after elimination of early discharges as described above (Fig. 2).…”

Section: Methodsmentioning

confidence: 99%

“…Tilford and associates 46 at Arkansas Children's Hospital studied rates of severe TBI in the 0-to 21-year age range from 1988 through 1999 based on data from the NIS. As in the current study, Tilford defined severe injury on the basis of primary or secondary diagnostic codes for TBI associated with a procedural code for mechanical ventilation.…”

Section: Epidemiological Factorsmentioning

confidence: 99%

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Hospital care of childhood traumatic brain injury in the United States, 1997–2009: a neurosurgical perspective

Piatt

Neff

2012

PED

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Object The goal in this paper was to study hospital care for childhood traumatic brain injury (TBI) in a nationwide population base. Methods Data were acquired from the Kids' Inpatient Database (KID) for the years 1997, 2000, 2003, 2006, and 2009. Admission for TBI was defined by any ICD-9-CM diagnostic code for TBI. Admission for severe TBI was defined by a principal diagnostic code for TBI and a procedural code for mechanical ventilation; admissions ending in discharge home alive in less than 4 days were excluded. Results Estimated raw and population-based rates of admission for all TBI, for severe TBI, for death from severe TBI, and for major and minor neurosurgical procedures fell steadily during the study period. Median hospital charges for severe TBI rose steadily, even after adjustment for inflation, but estimated nationwide hospital charges were stable. Among 14,932 actual admissions for severe TBI captured in the KID, case mortality was stable through the study period, at 23.9%. In a multivariate analysis, commercial insurance (OR 0.86, CI 0.77–0.95; p = 0.004) and white race (OR 0.78, CI 0.70–0.87; p < 0.0005) were associated with lower mortality rates, but there was no association between these factors and commitment of resources, as measured by hospital charges or rates of major procedures. Increasing median income of home ZIP code was associated with higher hospital charges and higher rates of major and minor procedures. Only 46.8% of admissions for severe TBI were coded for a neurosurgical procedure of any kind. Fewer admissions were coded for minor neurosurgical procedures than anticipated, and the state-by-state variance in rates of minor procedures was twice as great as for major procedures. Possible explanations for the “missing ICP monitors” are discussed. Conclusions Childhood brain trauma is a shrinking sector of neurosurgical hospital practice. Racial and economic disparities in mortality rates were confirmed in this study, but they were not explained by available metrics of resource commitment. Vigilance is required to continue to supply neurosurgical expertise to the multidisciplinary care process.

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Section: The Missing Icp Monitorsmentioning

confidence: 76%

Section: Mortality Ratesmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Epidemiological Factorsmentioning

confidence: 99%

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Hospital care of childhood traumatic brain injury in the United States, 1997–2009: a neurosurgical perspective

Piatt

Neff

2012

PED

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“…45,46,55,56 Absence of insurance coverage, so-called "self-pay" status, is a particularly adverse factor. 24,43,55,56 In the pediatric age range, however, trauma patients admitted without insurance often acquire retroactive Medicaid coverage, and this coverage is registered in discharge data if the hospital stay is long enough. Patients with no insurance who die of their injuries tend to have relatively short lengths of stay in the hospital and may fail to acquire Medicaid coverage before discharge data are registered.…”

Section: Discussionmentioning

confidence: 99%

Pediatric spinal injury in the US: epidemiology and disparities

Piatt¹

2015

PED

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OBJECT In the US, race and economic status have pervasive associations with mechanisms of injury, severity of injury, management, and outcomes of trauma. The goal of the current study was to examine these relationships on a large scale in the setting of pediatric spinal injury. METHODS Admissions for spinal fracture without or with spinal cord injury (SCI), spinal dislocation, and SCI without radiographic abnormality were identified in the Kids’ Inpatient Database (KID) and the National Trauma Data Bank (NTDB) registry for 2009. Patients ranged in age from birth up to 21 years. Data from the KID were used to estimate nationwide annual incidences. Data from the NTDB were used to describe patterns of injury in relation to age, race, and payor, with corroboration from the KID. Multiple logistic regression was used to model rates of mortality and spinal fusion. RESULTS In 2009, the estimated incidence of hospital admission for spinal injury in the US was 170 per 1 million in the population under 21 years of age. The incidence of SCI was 24 per 1 million. Incidences varied regionally. Adolescents predominated. Patterns of injury varied by age, race, and payor. Black patients were more severely injured than patients of other races as measured by Injury Severity Scale scores. Among black patients with spinal injury in the NTDB, 23.9% suffered firearm injuries; only 1% of white patients suffered firearm injuries. The overall mortality rate in the NTDB was 3.9%. In a multivariate analysis that included a large panel of clinical and nonclinical factors, black race retained significance as a predictor of mortality (p = 0.006; adjusted OR 1.571 [1.141–2.163]). Rates of spinal fusion were associated with race and payor in the NTDB data and with payor in the KID: patients with better insurance underwent spinal fusion at higher rates. CONCLUSIONS The epidemiology of pediatric spinal injury in the US cannot be understood apart from considerations of race and economic status.

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Variation in Intracranial Pressure Monitoring and Outcomes in Pediatric Traumatic Brain Injury

Bennett¹,

Riva-Cambrin²,

Keenan³

et al. 2012

Arch Pediatr Adolesc Med

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Hospitalizations for critically ill children with traumatic brain injuries: A longitudinal analysis*

Abstract: More aggressive management of pediatric traumatic brain injury appears to have contributed to reduced mortality rates over time and saved thousands of lives. Additional lives could be saved if mortality rates could be equalized between insured and uninsured children.

Cited by 61 publications

References 37 publications

Hospital care of childhood traumatic brain injury in the United States, 1997–2009: a neurosurgical perspective

Hospital care of childhood traumatic brain injury in the United States, 1997–2009: a neurosurgical perspective

Pediatric spinal injury in the US: epidemiology and disparities

Variation in Intracranial Pressure Monitoring and Outcomes in Pediatric Traumatic Brain Injury

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