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Craniotomy and Craniectomy in Pediatric Level I Versus Level II Trauma Centers: An Outcomes-Based Assessment
Muhammad Khurrum, *Marion Henry, Mohamad Chehab, Samer Asmar, Michael Ditillo, Molly Douglas, Lynn Gries, Bellal Joseph
University Of Arizona, Tucson, AZ

Background (issue):
Craniotomy and craniectomy are commonly performed in pediatric traumatic brain injury (TBI) patients. Our study aims to assess whether patients undergoing craniotomy/craniectomy for severe TBI fare better at pediatric Level I than pediatric Level II trauma centers.
Methods:
We performed a year (2017) analysis of the ACS-TQIP. We included pediatric patients (<18y) with isolated severe TBI (head-AIS>3 & extracranial-AIS≤3) who underwent craniotomy/craniectomy. Transferred or dead on arrival patients were excluded. Outcome measures included in-hospital mortality, major-complications, hospital, and ICU LOS. Multivariable regression and Kaplan-Meier survival analysis were performed.
Findings:
Of 928 patients, 618 patients were treated at Level I, and 310 were treated at level II pediatric trauma centers. Mean age was 95, median head-AIS was 4[4-5], and median ISS was 22[17-29]. Baseline characteristics were similar between the two groups including ED SBP (p=0.54), ED GCS (p=0.61), Head-AIS (p=0.18), and ISS (p=0.26). In-hospital mortality was 11.8% in Level I vs. 16.8% in Level II centers. In multivariate analysis, treatment at Level I trauma centers was associated with significantly reduced in-hospital mortality (OR,0.67[0.42-0.87]; p<0.01). Hospital LOS was significantly longer in the Level I trauma center (p=0.03). There was no significant difference in major complications and ICU LOS.
Conclusions (implications for practice):
Mortality rates in patients undergoing a neurosurgical procedure for severe TBI at pediatric Level I trauma centers are significantly lower compared to Level II pediatric trauma centers.


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