TY  - JOUR
PY  - 2015//
TI  - Facility characteristics and in-hospital pediatric mortality following severe traumatic brain injury
JO  - Journal of neurotrauma
A1  - Mills, Brianna
A1  - Rowhani-Rahbar, Ali
A1  - Simonetti, Joseph A.
A1  - Vavilala, Monica S.
SP  - 841
EP  - 846
VL  - 32
IS  - 11
N2  - More than 500,000 children sustain a traumatic brain injury (TBI) each year. Previous studies have described significant variation in in-hospital mortality following pediatric TBI. The aim of this study was to identify facility-level characteristics independently associated with 30-day in-hospital mortality following pediatric severe TBI. We hypothesized that, after accounting for injury severity and other patient-level characteristics that affect mortality, the characteristics of facilities where patients received care would be associated with in-hospital mortality. Using data from the National Trauma Data Bank from 2009-2012, we identified a cohort of 10,162 pediatric patients hospitalized with severe TBI in 436 facilities and investigated their risk of 30-day in-hospital mortality. Pre-specified facility-level characteristics (trauma certification level, teaching status, Census region, facility size, non-profit 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 South (Risk ratio [RR]=1.46; 95% confidence interval [CI] 1.25-1.71), Midwest (RR=1.43; 95% CI: 1.21-1.70), and West (RR=1.26; 95% CI 1.04-1.52) regions had a higher likelihood of 30-day in-hospital mortality compared to patients treated in the Northeast. Other facility-level characteristics were not found to be significant. To our knowledge, this is one of the first and largest investigations to identify regional variation in in-hospital mortality following pediatric severe TBI in a large national sample while accounting for individual and facility-level characteristics. Further investigations to help explain this variation are needed to inform evidence-based decision-making in pediatric severe TBI care across different settings. <br><br>KEYWORDS: TBI (Traumatic Brain Injury), Hospital Mortality, Pediatrics, Facility characteristics, National Trauma Data Bank, Regional variation.<p />  <p>Language: en</p>
LA  - en
SN  - 0897-7151
UR  - http://dx.doi.org/10.1089/neu.2014.3733
ID  - ref1
ER  -