Quality Indicators for Children With Traumatic Brain Injury After Transition to an American College of Surgeons Level I Pediatric Trauma Center. Issue 1 (27th October 2020)

• Record Type: Journal Article
• Authors: Campbell, Maryellen; Zagel, Alicia L.; Ortega, Henry; Kreykes, Nathan; Tu, Albert; Linabery, Amy M.; Plasencia, Laura; Krause, Ernest; Bergmann, Kelly R.
• Is Part Of: Pediatric emergency care. Volume 38:Issue 1(2022)
• Page Start: e329
• Page End: e336
• Publication Date: 2020-10-27
• Subjects: traumatic brain injury -- intracranial injury -- trauma -- trauma center; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000002276
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Supplemental digital content is available in the text. Abstract : Objective: The aim of the study was to compare quality indicators, including frequency of acute surgical and emergent interventions, and resource utilization before and after American College of Surgeons (ACS) level I trauma verification among children with moderate or severe traumatic brain injury (TBI). Methods: This is a retrospective review of patients younger than 18 years treated for moderate or severe TBI, as determined by International Classification of Disease codes. Our institution obtained ACS level I trauma verification in 2013. Outcomes during the pre-ACS (June 2003–May 2008), interim (June 2008–May 2013), and post-ACS (June 2013–May 2018) periods were compared via nonparametric tests. Tests for linear trend were conducted using Cochran-Armitage tests for categorical data and by linear regression for continuous variables. Results: There were 677 children with moderate or severe TBIs (pre-ACS, 125; interim, 198; post-ACS, 354). Frequency of any surgical intervention increased significantly in the post-ACS period (12.2%) compared with interim (5.1%) and pre-ACS periods (5.6%, P = 0.007). More children in the post-ACS period required intracranial pressure monitoring ( P = 0.017), external ventricular drain placement ( P = 0.003), or endotracheal intubation ( P = 0.001) compared with interim and pre-ACS periods. There was no significant change in time to operating room ( P = 0.514), frequency of decompression ( P = 0.096), or time to decompression ( P = 0.788) between study periods. The median time to head CT decreased significantly in the post-ACS period (26 minutes; interquartile range [IQR], 9–60) compared with interim (36 minutes; IQR, 21–69) and pre-ACS periods (53 minutes; IQR, 36–89; P < 0.001). Frequency of repeat head computed tomography decreased significantly in the post-ACS period (30.2%) compared with interim (56.1%) and pre-ACS periods (64.0%, P trend = 0.044). Conclusions: Transition to an ACS level I trauma verification was associated with improvements in quality indicators for children with moderate or severe TBI.