Prehospital and In-Hospital Mortality

Sills, Marion R.; Libby, Anne M.; Orton, Heather D.

doi:10.1001/archpedi.159.7.665

Cited by 43 publications

(6 citation statements)

References 26 publications

(18 reference statements)

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“…Similar to our findings, several studies have reported falls and transport incidents as leading causes of head injury and TBI admissions [13,14,15,16,17,18,19,20,21,22] and deaths [21,23,24,25]. However, in the USA, some studies have indicated that firearm-related events are the leading contributor to TBI-related mortality [7,22].…”

Section: Discussionsupporting

confidence: 90%

Head Injury Incidence and Mortality in New Zealand over 10 Years

Kool

Chelimo²,

Ameratunga³

2013

Neuroepidemiology

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Background: Although reducing the burden of head injuries is an important focus of several injury prevention initiatives, they remain a large proportion of injury-related deaths. In New Zealand, trends over time and the socio-economic distribution of the cause-specific incidence of head injuries have received little attention. Methods: We analyzed primary hospitalizations (2000-2009) and deaths (1999-2008) due to head injury using national mortality and hospital discharge databases, specifically exploring variations in age-specific rates by major causes over time and by socio-economic deprivation. Population-based incidence rate estimates were calculated using census denominators. Results: Children aged <5 years and adults aged ≥65 years had the highest rates of hospitalization and mortality, respectively. Transport-related incidents and falls were the leading causes, with most fatal injuries occurring on roads and most hospitalized injuries occurring at home. There was a significant increase in mortality rates among older adults over the decade, and in most age groups, mortality rates increased with increasing levels of socio-economic deprivation. Conclusions: The findings of this review alongside the significant risks of premature death and disability reinforce the need to explore policies that address the specific causes as well as socio-economic inequalities in their distribution in New Zealand.

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Section: Discussionsupporting

confidence: 90%

Head Injury Incidence and Mortality in New Zealand over 10 Years

Kool

Chelimo²,

Ameratunga³

2013

Neuroepidemiology

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“…This is consistent with the findings of a previous review that synthesized the literature on the use of ICD codes in child maltreatment research and concluded that using code data alone may under-ascertain CM (9). Over the past decade, improvements have been made in standardizing the use of ICD coding for measuring child abuse (6,14,28). However, it is likely that research limited to ICD coded administrative databases continue to underestimate the incidence of child maltreatment.…”

Section: Discussionmentioning

confidence: 99%

Abusive head trauma among children in Alaska: a population-based assessment

Parrish

Baldwin-Johnson

Volz

et al. 2013

International Journal of Circumpolar Health

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BackgroundSerious physical abuse resulting in a traumatic brain injury (TBI) has been implicated as an underreported cause of infant mortality. Nearly 80% of all abusive head trauma (AHT) occurs among children <2 years of age, with infants experiencing an incidence nearly 8 times that of 2-year olds.ObjectiveThis study describes the validation of the CDC Pediatric Abusive Head Trauma (PAHT) definitions when applied to a multi-source database at the state level and provides a robust annual incidence estimate of AHT among children <2 years of age in Alaska.DesignAHT cases among children residing in Alaska during 2005–2010 were identified by applying the PAHT coding schema to a multi-source database which included vital death records, the Violent Death Reporting System (AK-VDRS), the Maternal Infant Mortality Review – Child Death Review (MIMR-CDR), the Alaska Trauma Registry (ATR), the inpatient Hospital Discharge Database (HDD) and Medicaid claims. Using these data, we calculated statewide AHT annual incidence rates.ResultsThe databases with the highest case capture rates were the ATR and Medicaid systems, both at 51%, followed by HDD at 38%. Combined, the ATR, HDD and Medicaid systems captured 91% of all AHT cases. The linkage and use of the PAHT definitions yielded an estimated sensitivity of 91% and specificity of 98%. During the study period, we detected an annual average incidence of 34.4 cases per 100,000 children aged <2 years (95% CI 25.1, 46.1) and a case fatality proportion of 22% (10/45). Among the AHT cases, 82% were infants. Significant differences (p < 0.05) in AHT were noted by age and race, but not by sex.ConclusionsIn Alaska, applying the CDC PAHT definition to the multi-source database enabled us to capture 49% more AHT cases than any of the individual database used in this analysis alone.

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“…(1) Outcomes after pediatric TBI depend on factors such as age, injury severity and intent of injury,(2–4) but timely and high quality acute care is also of vital importance. (5–8) Publication of the 2003 and 2012 pediatric TBI guidelines represent important interdisciplinary efforts to provide guidance on provision of evidence-based acute care for infants and children with severe TBI.…”

Section: Introductionmentioning

confidence: 99%

Guideline Adherence and Hospital Costs in Pediatric Severe Traumatic Brain Injury*

Graves

Kannan

Mink

et al. 2016

Pediatric Critical Care Medicine

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Objective Adherence to pediatric traumatic brain injury (TBI) guidelines has been associated with improved survival and better functional outcome. However, the relationship between guideline adherence and hospitalization costs has not been examined. To evaluate the relationship between adherence to pediatric severe TBI guidelines, measured by acute care clinical indicators, and the total costs of hospitalization associated with severe TBI. Design Retrospective cohort study Setting Five regional pediatric trauma centers affiliated with academic medical centers. Patients Demographic, injury, treatment, and charge data were included for pediatric patients (age under 17 years) with severe traumatic brain injury. Measurements Percent adherence to clinical indicators was determined for each patient. Cost-to-charge ratios were used to estimate ICU and total hospital costs for each patient. Generalized linear models evaluated the association between healthcare costs and adherence rate. Main Results Cost data for 235 patients were examined. Estimated mean adjusted hospital costs were $103,485 (95% CI: 98,553–108,416); adjusted ICU costs were $82,071 (95% CI: 78,559–85,582). No association was found between adherence to guidelines and total hospital or ICU costs, after adjusting for patient and injury characteristics. Adjusted regression model results provided cost ratio equal to 1.01 for hospital and ICU costs (95% CI: 0.99–1.03 and 0.99–1.02, respectively). Conclusions Adherence to severe pediatric traumatic brain injury guidelines at these 5 leading pediatric trauma centers was not associated with increased hospitalization and ICU costs. Therefore, cost should not be a factor as institutions and providers strive to provide evidence based guideline driven care of children with severe TBI.

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Prehospital and In-Hospital Mortality

Abstract: Intentionality--independent of severity--raises the mortality of TBI in young children.

Cited by 43 publications

References 26 publications

Head Injury Incidence and Mortality in New Zealand over 10 Years

Head Injury Incidence and Mortality in New Zealand over 10 Years

Abusive head trauma among children in Alaska: a population-based assessment

Guideline Adherence and Hospital Costs in Pediatric Severe Traumatic Brain Injury*

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