Generalizability of pediatric major trauma experience to severe pediatric traumatic brain injury at level 1 and 2 trauma centers

Abstract

Background: To examine the volume-outcome relationship in severe pediatric traumatic brain injury (TBI) using a retrospective analysis and to determine whether volume as a measure of broader trauma experience may generalize to favor improved pediatric TBI outcomes. Methods: We isolated all pediatric admissions for severe TBI (GCS admission score 3–8) to Pediatric ACS Level I and II Trauma Centers in the 2012–2015 National Trauma Data Bank. Using multivariate regression analysis, we examined the impact of four distinct volume variables—pediatric severe TBI, pediatric major trauma, adult severe TBI, and adult major trauma—on severe pediatric TBI short-term outcomes. Each volume measure was analyzed continuously as a primary independent variable. Our primary outcome variable was hospital discharge disposition. We adjusted for patient demographics, hospital characteristics, trauma severity metrics, and field-to-hospital time. Results: A total of 5,425 severe pediatric TBI patients were included in the final study population. Following multivariate analysis, only higher pediatric major trauma volume was associated with higher odds of favorable discharge [OR =1.073, 95% CI: (1.033, 1.114) per +100 patients, P<0.001]. Major pediatric trauma volume was also associated with shorter hospital ( ‒ 0.21 days per +100 patients, P=0.035) and ICU LOS ( ‒ 0.16 days per +100 patients, P=0.011). Both pediatric trauma and TBI volume were correlated with lower complication rates [Major Pediatric Trauma: OR =0.956, (0.921, 0.992) per +100 patients, P=0.018; Severe Pediatric TBI: OR =0.824, (0.728, 0.933) per +100 patients, P=0.002], particularly ARDS [Major Pediatric Trauma: OR =0.851, (0.783, 0.924) per +100 patients, P<0.001, Severe Pediatric TBI: OR =0.505, (0.372, 0.684) per +100 patients, P<0.001]. Conclusions: Among four different volume metrics, pediatric major trauma volume was correlated with more favorable discharge. General pediatric trauma experience was also associated with lower complication rates, particularly ARDS. An institution’s adult trauma and TBI experience did not significantly influence severe pediatric TBI outcomes. 17