Severe traumatic brain injuries in children: Does the type of trauma center matter?

Bardes, James M.; Benjamin, Elizabeth; Escalante, Agustín; Wu, Jinglan; Δημητριάδης, Δημήτριος

doi:10.1016/j.jpedsurg.2017.09.017

Cited by 10 publications

(14 citation statements)

References 9 publications

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“…Despite high rates of chronic conditions, most PNCC patients were not treated at a children’s hospital consistent with previous reports. [1] Children with TBI have been reported to have better outcomes when treated at a children’s hospital,[51] and the effect of treatment at a children’s hospital on outcome should be investigated further for other PNCC populations. Several disease and patient specific factors contribute to risk for poor outcomes that are not well evaluated with administrative data.…”

Section: Discussionmentioning

confidence: 99%

The Burden of Pediatric Neurocritical Care in the United States

Williams

Piantino²,

McEvoy³

et al. 2018

Pediatric Neurology

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Background: Pediatric Neurocritical Care (PNCC) diseases affect thousands of children annually. We aimed to quantify the burden of PNCC through generation of national estimates of disease incidence, utilization of critical care interventions (CCI), and hospital outcomes. Methods: We performed a retrospective cohort analysis of the Kids Inpatient Database over three years to evaluate pediatric traumatic brain injury, neuro-infection or inflammatory diseases, status epilepticus, stroke, hypoxic ischemic injury after cardiac arrest, and spinal cord injury. We evaluated use of CCI, death, length of stay, hospital charges, and poor functional outcome defined as receipt of tracheostomy or gastrostomy or discharge to a medical care facility. Results: At least one CCI was recorded in 67,058 (23%) children with a primary neurologic diagnosis, and considered a PNCC admission. Over half of PNCC admissions had at least one chronic condition, and 23% were treated in children’s hospitals. Mechanical ventilation was the most common CCI, but utilization of CCIs varied significantly by diagnosis. Among PNCC admissions, 8,110 (12%) children died during hospitalization and 14,067 (21%) children had poor functional outcomes. PNCC admissions accounted for over 1.5 million hospital days and over $4 billion in hospital costs cumulatively in the study years. Most PNCC admissions, across all diagnoses, had prolonged hospitalizations >1 week with an average cost of $39.9 thousand per admission. Conclusion: This large, nationally representative study shows PNCC diseases are a significant public health burden with substantial risk to children’s health. More research is needed to improve outcomes in these vulnerable children.

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Section: Discussionmentioning

confidence: 99%

The Burden of Pediatric Neurocritical Care in the United States

Williams

Piantino²,

McEvoy³

et al. 2018

Pediatric Neurology

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“…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).…”

Section: Resultsmentioning

confidence: 99%

“…Confounding bias was rated serious for 11 studies (17%), mostly due to the absence of physiological parameters (eg, Glasgow coma scale or hemodynamic stability) in administrative data. Bias due to classification of the intervention was rated low for 27 studies (79%), with some studies rated moderate because trauma centers were not accredited or verified by the same organizations (eg, state-designated with or without American College of Surgeons [ACS] verification). Similarly, deviations from the intervention were rated low for 26 studies (76%), with 11 rated moderate because they included but did not control for interhospital transfers.…”

Section: Resultsmentioning

confidence: 99%

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

Moore,

Freire,

Turgeon

et al. 2023

JAMA Netw Open

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ImportanceAdult trauma centers (ATCs) have been shown to decrease injury mortality and morbidity in major trauma, but a synthesis of evidence for pediatric trauma centers (PTCs) is lacking.ObjectiveTo assess the effectiveness of PTCs compared with ATCs, combined trauma centers (CTCs), or nondesignated hospitals in reducing mortality and morbidity among children admitted to hospitals following trauma.Data SourcesMEDLINE, Embase, and Web of Science through March 2023.Study SelectionStudies comparing PTCs with ATCs, CTCs, or nondesignated hospitals for pediatric trauma populations (aged ≤19 years).Data Extraction and SynthesisThis systematic review and meta-analysis was performed following the Preferred Reporting Items for Systematic Review and Meta-analysis and Meta-analysis of Observational Studies in Epidemiology guidelines. Pairs of reviewers independently extracted data and evaluated risk of bias using the Risk of Bias in Nonrandomized Studies of Interventions tool. A meta-analysis was conducted if more than 2 studies evaluated the same intervention-comparator-outcome and controlled minimally for age and injury severity. Subgroup analyses were planned for age, injury type and severity, trauma center designation level and verification body, country, and year of conduct. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess certainty of evidence.Main Outcome(s) and Measure(s)Primary outcomes were mortality, complications, functional status, discharge destination, and quality of life. Secondary outcomes were resource use and processes of care, including computed tomography (CT) and operative management of blunt solid organ injury (SOI).ResultsA total of 56 studies with 286 051 participants were included overall, and 34 were included in the meta-analysis. When compared with ATCs, PTCs were associated with a 41% lower risk of mortality (OR, 0.59; 95% CI, 0.46-0.76), a 52% lower risk of CT use (OR, 0.48; 95% CI, 0.26-0.89) and a 64% lower risk of operative management for blunt SOI (OR, 0.36; 95% CI, 0.23-0.57). The OR for complications was 0.80 (95% CI, 0.41-1.56). There was no association for mortality for older children (OR, 0.71; 95% CI, 0.47-1.06), and the association was closer to the null when PTCs were compared with CTCs (OR, 0.73; 95% CI, 0.53-0.99). Results remained similar for other subgroup analyses. GRADE certainty of evidence was very low for all outcomes.Conclusions and RelevanceIn this systematic review and meta-analysis, results suggested that PTCs were associated with lower odds of mortality, CT use, and operative management for SOI than ATCs for children admitted to hospitals following trauma, but certainty of evidence was very low. Future studies should strive to address selection and confounding biases.

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“…Previous work has found lower mortality among younger pediatric patients-including those with TBIs -treated at PTCs versus ATCs and MTCs. 6,[12][13][14] However, this benefit does not seem to extend to adolescent patients. [7][8][9][10]15 The analysis by Gross et al, 15 the closest comparison to this study, looked at the same patient population and arrived at similar conclusions, but used data from only a single state (Pennsylvania) instead of the national sample used here.…”

Section: Discussionmentioning

confidence: 99%

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

Sheff¹,

Engbrecht²,

Rodgers³

et al. 2022

J Trauma Acute Care Surg

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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.

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Severe traumatic brain injuries in children: Does the type of trauma center matter?

Cited by 10 publications

References 9 publications

The Burden of Pediatric Neurocritical Care in the United States

The Burden of Pediatric Neurocritical Care in the United States

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

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

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