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The Utah Pediatric Trauma Network, a State-wide Pediatric Trauma Collaborative Can Safely Help Non-pediatric Trauma Hospitals Admit Children With Mild Traumatic Brain Injury
*Stephen J. Fenton, *Robert A. Swendiman, Matthew Eyre, Kezlyn Larsen, *Katie W. Russell
University of Utah School of Medicine, Salt Lake City, UT

Background: Created in 2019, the Utah Pediatric Trauma Network (UPTN) is a transparent, non-competitive collaboration of all hospitals in Utah with the purpose of improving pediatric trauma care. The UPTN implemented evidence-based guidelines based on hospital resources and capabilities with quarterly review of data collected in a network-specific database. The first initiative was to help triage the care of traumatic brain injury (TBI) to prevent unnecessary transfers while ensuring appropriate care. The purpose of this study was to review the effectiveness of this network wide guideline. Methods: The UPTN REDCap® database was retrospectively reviewed between 1/2019-12/2021. Comparisons were made between the pediatric trauma center (PED1) and non-pediatric hospitals (non-PED1) in admissions of children with very mild (VM), mild (M), or complicated mild (CM) TBI.
Findings: Of the 3315 cases, 294 were admitted to a non-PED1 hospital and 1061 to the PED1 hospital with VM/M/CM TBI. Overall, kids treated at non-PED1 were older (mean 14.9 v. 7.7 years,p=0.00001) and more likely to be ≥14 years (37% v. 24%,p<0.00001) compared to those at PED1. Increased admissions occurred in 2020-2021 at non-PED1 hospitals compared to 2019 (43% v. 14%,p<0.00001). Children admitted to non-PED1 hospitals in 2020-2021 were younger (9.1 v. 15.7 years, p=0.002) with more kids <14 years (67% v. 38%,p=0.014) compared to 2019. Two kids required next-day transfer to a higher-level center (1 to PED1), none required surgery or neurosurgical evaluation. Mean length of stay was 21.8 hours (IQR 11.9, 25.4). Concomitantly, less children with VM TBI were admitted to PED1 in 2020-2021 (6% v. 27%,p<0.00001), and more with CM TBI (63% v. 50%,p=0.00003) than 2019.
Conclusions: Implementation of TBI guidelines across the UPTN successfully allowed non-pediatric hospitals to safely admit children with very mild, mild, or complicated mild TBI. Additionally, admitted kids were more like those treated at the PED1 hospital.


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