Variation in therapy and outcome for pediatric head trauma patients

Tilford, John M.; Simpson, Pippa; Yeh, Timothy S.; Lensing, Shelly; Aitken, Mary E.; Green, Jerril W.; Harr, Judith; Fiser, Debra H.

doi:10.1097/00003246-200105000-00037

Cited by 110 publications

(64 citation statements)

References 38 publications

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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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Section: Discussionmentioning

confidence: 99%

Pediatric spinal injury in the US: epidemiology and disparities

Piatt¹

2015

PED

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“…Large prospective randomized clinical trails are essential to compare the efficacy of different strategies [32,37,38,39,40]. These are not easy to perform in children with severe TBI since the number of children treated at each center is low.…”

Section: Discussionmentioning

confidence: 99%

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

et al. 2005

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Objective: This study evaluated the outcome of treatment according to the Lund concept in children with severe traumatic brain injury and investigated whether the preset goals of the protocol were achieved. Design and setting: A twocenter retrospective study in neurointensive care units at university hospitals. Patients: Forty-one children with severe traumatic brain injury from blunt trauma and arriving at hospital within 24 h after injury. Median age was 8.8 years (range 3 months-14.2 years), Glasgow Coma Scale 7 (3-8), and Injury Severity Score 25 (16-75). All children had pathological findings on initial computed tomography. All developed intracranial hypertension, and survivors required intensive care longer than 72 h. Interventions: Treatment according to the principles of the Lund concept. Measurements and results: Neurosurgery was required in 46% of the children. Survival rate was 93% and favorable outcome (Glasgow Outcome Score 4 or 5) was 80% at long-term follow-up (median 12 months postinjury, range 2.5-26). The preset physiological and biochemical goals were achieved in over 90% of observations. Conclusions: Treating pediatric patients with severe traumatic brain injury, according to the Lund concept, results in a favorable outcome when the protocol is followed.

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“…27 These investigators also found that neurologists and neurosurgeons differed in the intensity with which they approached the same type of clinical problem within one institution, again highlighting the variable care that patients may receive according to where and by whom they are cared for. 27 Others have found influences on outcome according to whether patients are admitted to a general or to a neurosurgical ICU 28 or whether surgical intervention is early or delayed, 29 in the use of induced hypothermia, seizure medications, paralytic agents, 30 use of intracranial monitoring, 30,31 or according to physician prediction of severely impaired future cognitive function. 32 …”

Section: Predicting Mortalitymentioning

confidence: 99%