title: Benchmarking Prehospital and Emergency Department Care for Argentine Children with Traumatic Brain Injury: For the South American Guideline Adherence Group.
abstract: OBJECTIVE
  There is little information on the type of early care provided to children with traumatic brain injury (TBI) in low middle income countries. We benchmarked early prehospital [PH] and emergency department [ED] pediatric TBI care in Argentina.
  
  
  METHODS
  We conducted a secondary analysis of data from patients previously enrolled in a prospective seven center study of children with TBI. Eligible participants were patients 0-18 years, and had diagnosis of TBI (admission Glasgow Coma scale score [GCS] < 13 or with GCS 14-15 and abnormal head CT scan within 48 hours of admission, and head AIS > 0). Outcomes were transport type, transport time, PH and ED adherence to best practice, and discharge Pediatric Cerebral Performance Category Scale (PCPC) and Pediatric Overall Performance category Scale (POPC).
  
  
  RESULTS
  Of the 366 children, mean age was 8.7 (5.0) years, 58% were male, 90% had isolated TBI and 45.4% were transported by private vehicle. 50 (34.7%) of the 144 children with severe TBI (39.3% of all TBI patients) were transported by private vehicle. Most (267; 73%) patients received initial TBI care at an index hospital prior to study center admission, including children with severe (81.9%) TBI. Transport times were shorter for those patients who were directly transported by ambulance to study center than for the whole cohort (1.4 vs.5.5 hours). Ambulance blood pressure data were recorded in 30.9%. ED guideline adherence rate was higher than PH guideline adherence rate (84.8% vs. 26.4%). For patients directly transferred from scene to study trauma centers, longer transport time was associated with worse discharge outcome (PCPC aOR 1.10 [1.04, 1.18] and (POPC aOR 1.10 [1.04, 1.18]). There was no relationship between PH or ED TBI guideline adherence rate and discharge POPC and PCPC.
  
  
  CONCLUSIONS
  This study benchmarks early pediatric TBI care in Argentina and shows that many critically injured children with TBI do not receive timely or best practice PH care, that PH guideline adherence rate is low and that longer transport time was associated with poor discharge outcomes for patients with direct transfer status. There is an urgent need to improve the early care of children with TBI in Argentina, especially timely transportation to a hospital.
authors.affiliation: Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, United States of America.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.affiliation: Centro de Informática e Investigación Clínica, Rosario, Santa Fe, Argentina.|Hospital de emergencias Dr. Clemente Álvarez, Rosario, Santa Fe, Argentina.
authors.forename: Silvia B
authors.initials: SB
authors.lastname: Lujan
authors.affiliation: Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, United States of America.
authors.forename: Qian
authors.initials: Q
authors.lastname: Qiu
authors.affiliation: Centro de Informática e Investigación Clínica, Rosario, Santa Fe, Argentina.|Hospital de emergencias Dr. Clemente Álvarez, Rosario, Santa Fe, Argentina.
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Petroni
authors.affiliation: Centro de Informática e Investigación Clínica, Rosario, Santa Fe, Argentina.
authors.forename: Nicolás M
authors.initials: NM
authors.lastname: Ballarini
authors.affiliation: Centro de Informática e Investigación Clínica, Rosario, Santa Fe, Argentina.
authors.forename: Nahuel
authors.initials: N
authors.lastname: Guadagnoli
authors.affiliation: Centro de Informática e Investigación Clínica, Rosario, Santa Fe, Argentina.
authors.forename: María Alejandra
authors.initials: MA
authors.lastname: Depetris
authors.affiliation: Hospital de Niños Víctor J Vilela, Rosario, Santa Fe, Argentina.
authors.forename: Gabriela A
authors.initials: GA
authors.lastname: Faguaga
authors.affiliation: Hospital de Niños Víctor J Vilela, Rosario, Santa Fe, Argentina.
authors.forename: Gloria M
authors.initials: GM
authors.lastname: Baggio
authors.affiliation: Hospital El Cruce. Ezpeleta Oeste, Buenos Aires, Argentina.
authors.forename: Leonardo O
authors.initials: LO
authors.lastname: Busso
authors.affiliation: Hospital de Niños Sor María Ludovica, La Plata, Buenos Aires, Argentina.
authors.forename: Mirta E
authors.initials: ME
authors.lastname: García
authors.affiliation: Hospital de Niños Dr. Orlando Alassia, Santa Fe, Santa Fe, Argentina.
authors.forename: Osvaldo R
authors.initials: OR
authors.lastname: González Carrillo
authors.affiliation: Hospital Interzonal Especializado Materno Infantil Dr. Vitorio Tetamanti, Mar del Plata, Buenos Aires, Argentina.
authors.forename: Paula L
authors.initials: PL
authors.lastname: Medici
authors.affiliation: Hospital de Niños de la Santísima Trinidad, Córdoba, Cordoba, Argentina.
authors.forename: Silvia S
authors.initials: SS
authors.lastname: Sáenz
authors.affiliation: Hospital Pediátrico Dr. Humberto Notti, Mendoza, Mendoza, Argentina.
authors.forename: Elida E
authors.initials: EE
authors.lastname: Vanella
authors.affiliation: Graduate School of Public Health, Epidemiology Data Coordinating Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Anthony
authors.initials: A
authors.lastname: Fabio
authors.affiliation: Neurological Surgery and Pediatrics, Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bell
mesh_terms: D000293:Adolescent; D001118:Argentina; D019985:Benchmarking; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D019983:Guideline Adherence; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014187:Transportation of Patients