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Pre-Hospital Care of Children with Traumatic Brain Injury

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Pre-Hospital Care of Children with Traumatic Brain Injury
Lawrence J Cook1 , Mengtao Dai1 , N. Clay Mann1 , and Tellen D Bennett2
1University of Utah School of Medicine, Department of Pediatrics Division of Critical Care; 2University of Colorado School of Medicine, Childrens Hospital Colorado, Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS)

Methods: Pediatric patients in statewide emergency medical services (EMS), trauma registry, and the Pediatric Health Information (PHIS) databases were probabilistically linked. Results: Over 5 years (2009-2013), the EMS, trauma registry, and PHIS records were linked with good confidence for 439 children with moderate (148/439, 34%) or severe (291/439, 65%) TBI. The mean age was 7.0 years (SD 5.1) and 258/439(59%) of the patients were male. Most patients (285/439,65%) were transferred from a referring hospital to a pediatric trauma center. 12/439 (4%) patients were transported by a pediatric flight team. The median time to definitive pediatric care, our primary exposure, was 140 minutes (IQR 74-259). The overall median hospital length of stay was 4 days and the median ICU length of stay was 2 days. Mortality was 18%. Children with time to definitive care in the top quartile (259 – 1,739 minutes) compared to those in the bottom quartile (9 - 74 minutes) had lower mortality (11% vs 28%, p=0.003 ) and survivors had longer hospital length of stay (5 days vs 1 days, p<0.001).

Objective: Understanding how pre-hospital decisions affect the outcomes of children with TBI is an important step to improving pediatric trauma care.

Objective Content: To test the impact of time to definitive pediatric care, a priori defined as care by a pediatric transport team or at a designated pediatric trauma center, on intensive care unit (ICU) and hospital length of stay and mortality in hospitalized children with moderate (GCS 9-12) or severe (GCS ≤ 8) TBI.


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