Neurosurgical care for pediatric isolated severe traumatic brain injury in American College of Surgeons Committee on Trauma-verified pediatric trauma centers is accompanied by improved outcomes compared with care in adult trauma centers.

Abstract

The American College of Surgeons Committee on Trauma level verification system directs severely injured patients to specialized centers, a strategy that has been associated with improved outcomes. The correlation between outcome of pediatric trauma patients requiring surgical procedures and verification status of the treating institution is not well established. This study aims to examine the association between outcomes following isolated severe traumatic brain injury (iSTBI) and pediatric trauma center (PTC) verification status. This study analyzed data from the American College of Surgeons Trauma Quality Improvement Program for pediatric patients (<18 years) from 2013 to 2021 with iSTBI, defined as a head Abbreviated Injury Scale score ≥3 for intracranial pathology and Abbreviated Injury Scale score ≤1 in all other regions, resulting from blunt trauma and requiring neurosurgical intervention. Patients treated at Level I or Level II adult trauma centers without pediatric verification (ATCs) were compared with those treated at PTCs. Demographics, injury characteristics, and outcomes were collected. Inverse probability weighting was applied to adjust for baseline differences. A total of 1,894 pediatric patients with surgically managed iSTBI, of whom 53% (n = 1,007) receiving treatment at a PTC, were included for further analysis. Following inverse probability weighting, treatment at a PTC correlated with a 30% lower risk of in-hospital mortality (relative risk, 0.70; 95% confidence interval, 0.55-0.90; p = 0.005) and a 63% decrease in the probability of failure-to-rescue (relative risk, 0.37; 95% confidence interval, 0.22-0.65; p < 0.001], in comparison to treatment at an ATC. Pediatric patients with iSTBI requiring neurosurgical intervention experience significantly reduced mortality and failure-to-rescue rates when treated at the American College of Surgeons Committee on Trauma-verified PTCs compared with ATCs. Therapeutic; Level III.