Pediatric traumatic brain injury: Resource utilization and outcomes at adult versus pediatric trauma centers

Abstract

Introduction: Traumatic brain injury is the leading cause of trauma-related death in children. We hypothesized that children with isolated traumatic brain injury would experience differential outcomes when treated at pediatric versus adult or combined trauma centers. Methods: After institutional review board approval, the 2015 National Trauma Data Bank was queried for children up to age 16 years with isolated traumatic brain injury. Demographics and clinical outcomes were collected. Univariable and multivariable analyses were conducted to assess for predictors of in-hospital mortality and complications. Kaplan–Meier survival analysis was conducted. Results: A total of 3,766 children with isolated traumatic brain injury were identified; 1,060 (28%) were treated at pediatric trauma centers, 1,909 (51%) at adult trauma centers, and 797 (21%) at combined trauma centers. Subjects were 5 years old (median, interquartile range 1–12 years), 63% male, and 64% white. Higher blood pressure and lower injury severity score were associated with reduced mortality (P < .05). Increasing injury severity score was associated with higher mortality by multivariable logistic regression (odds ratio 1.57, P < .0001). There were no survival differences among hospital types (P = .88). Conclusion: Outcomes for children with isolated traumatic brain injury appear equal across different types of designated trauma centers. These findings may have implications for prehospital transport and triage guidelines.