U.S. Trends of ED Visits for Pediatric Traumatic Brain Injuries: Implications for Clinical Trials

Abstract

Our goal in this paper was to use the 2006–2013 Nationwide Emergency Department Sample (NEDS) database to describe trends of annual patient number, patient demographics and hospital characteristics of pediatric traumatic brain injuries (TBI) treated in U.S. emergency departments (EDs); and to use the same database to estimate the available sample sizes for various clinical trials of pediatric TBI cases. National estimates of patient demographics and hospital characteristics were calculated for pediatric TBI. Simulation analyses assessed the potential number of pediatric TBI cases from randomly selected hospitals for inclusion in future clinical trials under different scenarios. Between 2006 and 2013, the NEDS database estimated that of the 215,204,932 children who visited the ED, 6,089,930 (2.83%) had a TBI diagnosis. During the study period in the US EDs, pediatric TBI patients increased by 34.1%. Simulation analyses suggest that hospital EDs with annual TBI ED visits >1000, Levels I and II Trauma Centers, pediatric hospitals, and teaching hospitals will likely provide ample cases for pediatric TBI studies. However, recruiting severe pediatric TBI cases for clinical trials from a limited number of hospital EDs will be challenging due to small sample sizes. Pediatric TBI-related ED visits in the U.S. increased by over 30% from 2006 to 2013. Including unspecified head injury cases with ICD-9-CM code 959.01 would significantly change the national estimates and demographic patterns of pediatric TBI cases. Future clinical trials of children with TBI should conduct a careful feasibility assessment to estimate their sample size and study power in selected study sites.

Epidemiology of paediatric trauma presenting to US emergency departments: 2006–2012

“…That study also showed TBI associated with a concomitant 14.7% decline in injuries to the torso over the same study period—a similar trend suggested here in figure 4. Another recent report demonstrated a 25.9% increase in TBI over the same study period (that report did, however, also note a 4% decrease in that trend from 2012 to 2013, a year we do not capture here) 39. Our results also reflect the relative nature of primary diagnosis categorisation, where increased awareness of TBI and its effects40 41 may decrease the relative importance of other diagnoses, leading to an observed—but not actual—TBI uptrend.…”

Trial of life: Well infants presenting more than 24 h after head injury with a scalp haematoma: A 10‐year review

“…Paediatric head injury is a common and increasing reason for emergency department (ED) attendance world‐wide . While most injuries are minor, a small subset of patients will suffer traumatic brain injury, which is the leading cause of preventable death and disability amongst children .…”

Determining the accuracy of the Canadian Hospitals Injury Reporting and Prevention Program for the representation of the rates of mild traumatic brain injuries in Quebec

“…The two studies with similar designs to ours produced strikingly similar results. Chen et al, 25 who only considered ED visits in the United States, observed that between 2006 and 2013, for the ages 0 to 17 years, the fold increase in mTBI rates was 1.3; in CHIRPP it was 1.3 (when using all injuries as the denominator). Fridman et al, 13 who only considered the index concussion (as CHIRPP does-only the first visit for an injury is tabulated) reported that in the age group 5 to 18 years, there was a 3.7-fold increase for concussions between 2004 and 2013.…”