Table 1:
Characteristics of 224 Children from Five Trauma Centers Admitted to the Emergency Department (ED) with Severe Traumatic Brain Injury (TBI).
| Characteristics | N=224 N (%) |
|---|---|
| Demographic | |
| Age (years) | |
| < 1y | 42 (19) |
| 1 to < 5y | 48 (21) |
| 5 to <13y | 47 (21) |
| 13 to <18y | 87 (39) |
| Gender | |
| Male | 157 (70) |
| Clinical | |
| Head abbreviated injury severity score | |
| 3 or 4 | 100 (45) |
| 5 or 6 | 124 (55) |
| Injury severity score | |
| <15 | 15 (7) |
| ≥15 | 209 (93) |
| Inflicted injury | 50 (22) |
| Direct admit | 126 (56) |
| Head CT findings | |
| Epidural (EDH), subdural hematoma (SDH) or subarachnoid hemorrhage (SAH) | 192 (86) |
| Intracerebral hemorrhage | 70 (31) |
| Intraventricular hemorrhage | 46 (21) |
| Contusion | 89 (40) |
| Prehospital (PH) hypotension only (n = 200)* | 41 (21) |
| ED hypotension**only | 29 (13) |
| PH or ED hypotension | 57 (25) |
| Decompressive craniectomy± (n = 112) | 69 (62) |
| Outcome | |
| In-hospital mortality | 27 (12) |
| Glasgow outcome scale score at discharge for survivorsβ (n=197) | |
| Poor | 128 (65) |
| Good | 69 (35) |
| Organizational | |
| ED Length of stay (LOS) median (IQR) hours | 1.3 (0.9–2.7) |
| Trauma center designation | |
| Adult and pediatric I/II (2 centers) | 102 (46) |
| Pediatric only I/II (3 centers) | 122 (54) |
| Mean pediatric TBI patient volume per center≠ | |
| < 200 (2 centers) | 93 (42) |
| ≥ 200 (3 centers) | 131 (58) |
| Total number of ED bedside staff | |
| < 8 (2 centers) | 87 (39) |
| ≥ 8 (3 centers) | 137 (61) |
| Neurosurgery resident present in ED (2 centers) | 91 (41) |
Prehospital (PH) includes EMS (flight + ambulance or ambulance only) and Index hospital combined; PH blood pressure data missing for 24 children
Systemic hypotension definition= systolic blood pressure < 70 + 2 (age [years])
Decompressive craniectomy for high intracranial pressure (ICP), EDH, SDH or cerebral edema within 48 hours of trauma center admission; High intracranial hypertension (ICP) is defined as presence of cerebral herniation (unequal pupils or hypertension and bradycardia, as determined clinically), administration of mannitol or hypertonic saline, or ICP > 20 mm Hg if ICP monitor was placed
Glasgow outcome scale (GOS) score at discharge for survivors (n=197) is dichotomized to poor GOS (vegetative state & major impairment) and good GOS (minor impairment & baseline status)
Mean pediatric TBI patient volume per center = Total TBI (head abbreviated injury severity score > 1) patient (age <18 years) hospital volume for the period 2007–2011 (5 years) divided by 5 for each center