title: Facility characteristics and inhospital pediatric mortality after severe traumatic brain injury.
abstract: More than 500,000 children sustain a traumatic brain injury (TBI) each year. Previous studies have described significant variation in inhospital mortality after pediatric TBI. The aim of this study was to identify facility-level characteristics independently associated with 30-day inhospital mortality after pediatric severe TBI. We hypothesized that, even after accounting for patient-level characteristics associated with mortality, the characteristics of facilities where patients received care would be associated with inhospital mortality. Using data from the National Trauma Data Bank from 2009-2012, we identified a cohort of 6707 pediatric patients hospitalized with severe TBI in 391 facilities and investigated their risk of 30-day inhospital mortality. Pre-specified facility-level characteristics (trauma certification level, teaching status, census region, facility size, nonprofit status, and responsibility for pediatric trauma care) were added to a Poisson regression model that accounted for patient-level characteristics associated with mortality. In multivariable analyses, patients treated in facilities located in the Midwest (risk ratio [RR]=1.42; 95% confidence interval [CI] 1.12-1.81) and South (RR=1.39; 95% CI: 1.12-1.72) regions had higher likelihoods of 30-day inhospital mortality compared with patients treated in the Northeast. Other facility-level characteristics were not found to be significant. To our knowledge, this is one of the largest investigations to identify regional variation in inhospital mortality after pediatric severe TBI in a national sample after accounting for individual and other facility-level characteristics. Further investigations to help explain this variation are needed to inform evidence-based decision-making for pediatric severe TBI care across different settings.
authors: 1Department of Epidemiology, University of Washington, Seattle, Washington.
authors: Brianna
authors: B
authors: Mills
authors: 1Department of Epidemiology, University of Washington, Seattle, Washington.
authors: Ali
authors: A
authors: Rowhani-Rahbar
authors: 3Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington.
authors: Joseph A
authors: JA
authors: Simonetti
authors: 3Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington.|4Departments of Anesthesiology and Pain Medicine and Pediatrics, University of Washington, Seattle, Washington.
authors: Monica S
authors: MS
authors: Vavilala
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000401:mortality* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000639:trends*; D005260:Female; D006272:Health Facility Environment / Q000379:methods / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012720:Severity of Illness Index
keywords: National Trauma Data Bank; TBI; facility characteristics; hospital mortality; pediatrics; regional variation
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