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
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.
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.
Of 928 patients, 618 patients were treated at Level I, and 310 were treated at level II pediatric trauma centers. Mean age was 9±5, 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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