Mortality of adolescents with isolated traumatic brain injury does not vary with type of level I trauma center

Abstract

BACKGROUND:Pediatric patients with isolated severe traumatic brain injury (TBI) treated at pediatric trauma centers (PTCs) have lower mortality than those treated at adult trauma centers (ATCs) or mixed trauma centers (MTCs). The primary objective of this study was to determine if adolescent patients (15-17 years) with isolated severe TBI also benefited from treatment at PTCs. METHODS:This was a cross-sectional analysis using a national sample of adolescent trauma patients obtained from the American College of Surgeons' Trauma Quality Program Participant Use Files for 2013 to 2017 (n = 3,524). Mortality, the primary outcome variable, was compared between Level I PTCs, ATCs, and MTCs using multiple logistic regression controlling for patient characteristics and injury severity. Secondary outcomes included discharge disposition, utilization of craniotomy, intensive care unit (ICU) utilization, ICU length of stay (LOS), and hospital LOS. RESULTS:Prior to adjustment, patients treated at ATCs (odds ratio [OR], 2.76; p = 0.032) and MTCs (OR, 2.36; p = 0.070) appeared to be at greater risk of mortality than those treated at PTCs. However, after adjustment, this difference disappeared (ATC OR, 1.21; p = 0.733; MTC OR, 0.95; p = 0.919). Patients treated at ATCs and MTCs were more severely injured than those treated at PTCs and more likely to be admitted to an ICU (ATC OR, 2.12; p < 0.001; MTC OR, 1.91; p < 0.001). No other secondary outcome differed between center types. CONCLUSION:Adolescent patients with isolated severe TBI treated at ATCs and MTCs had similar mortality risk as those treated at PTCs. The difference in injury severity across center types warrants additional research.

Pediatric vs Adult or Mixed Trauma Centers in Children Admitted to Hospitals Following Trauma

“…Among 6860 records identified in the databases, 5369 titles and abstracts were screened, and 212 manuscripts were assessed for eligibility, of which 56, with 286 051 total participants, were included in the review (eFigure 1 in eAppendix 2 in Supplement 1). Forty-four studies (79%) were published after 2010 (eTable 5 in Supplement 1).…”

“…Among 6860 records identified in the databases, 5369 titles and abstracts were screened, and 212 manuscripts were assessed for eligibility, of which 56, 4 , 8 , 12 , 13 , 14 , 18 , 19 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 with 286 051 total participants, were included in the review (eFigure 1 in eAppendix 2 in Supplement 1 ). Forty-four studies (79%) were published after 2010 (eTable 5 in…”

“…Overall risk of bias was critical in 6 studies 13 , 32 , 35 , 18 , 54 , 70 (25%) for mortality, critical in all studies for complications, serious in all studies for CT use, and serious in 5 studies 31 , 52 , 54 , 64 , 69 (71%) for operative management of SOI ( Table 1 ). Selection bias was rated critical or serious in 28 8 , 13 , 14 , 18 , 27 , 29 , 31 , 32 , 33 , 34 , 35 , 38 , 41 , 50 , 54 , 55 , 57 , 58 , 62 , 63 , 67 , 69 , 70 studies (82%), either because participation in the trauma registry was voluntary or because a substantial proportion of patients were excluded (eg, missing data or patients transferred in). Confounding bias was rated serious for 11 studies 13 , 29 , 47 , 52 , 53 , 58 , 59 , 60 , 63 , 64 , 67 (17%), mostly due to the absence of physiological parameters (eg, Glasgow coma scale or hemodynamic stability) in administrative data.…”

Association between trauma center type and mortality for injured children with severe traumatic brain injury

“…Another study focused on assessing trauma center influences on mortality among adolescent patients (defined between age 15 and 17 years) with isolated severe TBI treated at level I ACS or state-designated trauma centers. 27 They demonstrated no difference between trauma center type and mortality following severe TBI. Their findings were recapitulated by a group examining the same population in levels I and II centers within a single American state.…”

“…Importantly, their study was limited by use of a simple regression model without accounting for clustering within centers, restriction to isolated TBI patients, and lack of adjustment for known confounders such as race, sex, injury mechanism, comorbidities, and center characteristics. Another study focused on assessing trauma center influences on mortality among adolescent patients (defined between age 15 and 17 years) with isolated severe TBI treated at level I ACS or state-designated trauma centers 27 . They demonstrated no difference between trauma center type and mortality following severe TBI.…”