Citation

Mills B, Rowhani-Rahbar A, Simonetti JA, Vavilala MS. J. Neurotrauma 2015; 32(11): 841-846.

Affiliation

University of Washington, Epidemiology , 1959 NE Pacific Street , Health Sciences Building F-250 , Box 357236 , Seattle, Washington, United States , 98195-7236 , Harborview Injury Prevention and Research Center, Seattle, Washington, United States ; brmills@uw.edu.

Copyright

(Copyright © 2015, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2014.3733

PMID

25654233

Abstract

More than 500,000 children sustain a traumatic brain injury (TBI) each year. Previous studies have described significant variation in in-hospital mortality following pediatric TBI. The aim of this study was to identify facility-level characteristics independently associated with 30-day in-hospital mortality following pediatric severe TBI. We hypothesized that, after accounting for injury severity and other patient-level characteristics that affect mortality, the characteristics of facilities where patients received care would be associated with in-hospital mortality. Using data from the National Trauma Data Bank from 2009-2012, we identified a cohort of 10,162 pediatric patients hospitalized with severe TBI in 436 facilities and investigated their risk of 30-day in-hospital mortality. Pre-specified facility-level characteristics (trauma certification level, teaching status, Census region, facility size, non-profit status and responsibility for pediatric trauma care) were added to a Poisson regression model that accounted for patient-level characteristics associated with mortality. In multivariable analyses, patients treated in facilities located in the South (Risk ratio [RR]=1.46; 95% confidence interval [CI] 1.25-1.71), Midwest (RR=1.43; 95% CI: 1.21-1.70), and West (RR=1.26; 95% CI 1.04-1.52) regions had a higher likelihood of 30-day in-hospital mortality compared to patients treated in the Northeast. Other facility-level characteristics were not found to be significant. To our knowledge, this is one of the first and largest investigations to identify regional variation in in-hospital mortality following pediatric severe TBI in a large national sample while accounting for individual and facility-level characteristics. Further investigations to help explain this variation are needed to inform evidence-based decision-making in pediatric severe TBI care across different settings.

KEYWORDS: TBI (Traumatic Brain Injury), Hospital Mortality, Pediatrics, Facility characteristics, National Trauma Data Bank, Regional variation.

Language: en