title: Pediatric sports-related traumatic brain injury in United States trauma centers.
abstract: OBJECTIVE Traumatic brain injury (TBI) in children is a significant public health concern estimated to result in over 500,000 emergency department (ED) visits and more than 60,000 hospitalizations in the United States annually. Sports activities are one important mechanism leading to pediatric TBI. In this study, the authors characterize the demographics of sports-related TBI in the pediatric population and identify predictors of prolonged hospitalization and of increased morbidity and mortality rates. METHODS Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from children (age 0-17 years) across 5 sports categories: fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged length of stay (LOS) in the hospital or intensive care unit (ICU), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α < 0.05, and the Bonferroni correction (set at significance threshold p = 0.01) for multiple comparisons was applied in each outcome analysis. RESULTS From 2003 to 2012, in total 3046 pediatric sports-related TBIs were recorded in the NTDB, and these injuries represented 11,614 incidents nationally after sample weighting. Fall or interpersonal contact events were the greatest contributors to sports-related TBI (47.4%). Mild TBI represented 87.1% of the injuries overall. Mean (± SEM) LOSs in the hospital and ICU were 2.68 ± 0.07 days and 2.73 ± 0.12 days, respectively. The overall mortality rate was 0.8%, and the prevalence of medical complications was 2.1% across all patients. Severities of head and extracranial injuries were significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Hypotension on admission to the ED was a significant predictor of failure to discharge to home (OR 0.05, 95% CI 0.03-0.07, p < 0.001). Traumatic brain injury incurred during roller sports was independently associated with prolonged hospital LOS compared with FIC events (mean increase 0.54 ± 0.15 days, p < 0.001). CONCLUSIONS In pediatric sports-related TBI, the severities of head and extracranial traumas are important predictors of patients developing acute medical complications, prolonged hospital and ICU LOSs, in-hospital mortality rates, and failure to discharge to home. Acute hypotension after a TBI event decreases the probability of successful discharge to home. Increasing TBI awareness and use of head-protective gear, particularly in high-velocity sports in older age groups, is necessary to prevent pediatric sports-related TBI or to improve outcomes after a TBI.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco; and.|Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.
authors.forename: John K
authors.initials: JK
authors.lastname: Yue
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco; and.|Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Winkler
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco; and.|Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.
authors.forename: John F
authors.initials: JF
authors.lastname: Burke
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco; and.|Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Chan
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco; and.|Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.
authors.forename: Sanjay S
authors.initials: SS
authors.lastname: Dhall
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco; and.
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco; and.|Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.
authors.forename: Geoffrey T
authors.initials: GT
authors.lastname: Manley
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco; and.|Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.
authors.forename: Phiroz E
authors.initials: PE
authors.lastname: Tarapore
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000453:epidemiology* / Q000628:therapy*; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D013177:Sports; D014193:Trauma Centers; D014481:United States
keywords: CCI = Charlson Comorbidity Index; ED = emergency department; FIC = fall or interpersonal contact; GCS = Glasgow Coma Scale; ICD-9 = International Classification of Diseases, Ninth Revision; ICU = intensive care unit; ISS = Injury Severity Score; LOS = length of stay; NSP = National Sample Program; NTDB = National Trauma Data Bank; TBI = traumatic brain injury; concussion; mortality; outcome; pediatric; sports; traumatic brain injury