OBJECTIVES: To describe the epidemiology of traumatic brain injury (TBI) among children in Maryland and to examine factors that influence hospital admission. METHODS: Statewide mortality, hospital discharge, and ambulatory care data were used to identify all TBI-related emergency department (ED) visits, hospitalizations, and deaths that occurred in 1998 to children aged 0-19 years according to the Centers for Disease Control and Prevention's standard case definition and protocol. Inpatient admission was modeled as a function of patient, injury, and hospital characteristics. RESULTS: The overall incidence of pediatric TBI (i.e., ED visits, hospitalizations, and deaths) in 1998 was 670/100,000. After controlling for injury severity and other factors, uninsured children were 40% less likely to be hospitalized (95% CI = 0.43 to 0.82) and children with Medicaid were 90% more likely to be hospitalized (95% CI = 1.42 to 2.54) than were those with private insurance. The presence of a major associated injury significantly influenced the likelihood of hospitalization, especially among children with a minor (OR = 8.8) to moderate (OR = 11.6) TBI. Children who presented to a trauma center hospital were significantly more likely to be hospitalized than children treated at a non-trauma center hospital, although this varied depending on income (OR = 1.8 for high versus low) and hospital volume (OR = 2.6 for a small hospital and OR = 29.0 for a large hospital). CONCLUSIONS: After adjusting for TBI severity and the presence of associated injuries, significant differences in hospitalization rates may exist among different patient subgroups and hospitals for children who sustain TBIs.
OBJECTIVES: To describe the epidemiology of traumatic brain injury (TBI) among children in Maryland and to examine factors that influence hospital admission. METHODS: Statewide mortality, hospital discharge, and ambulatory care data were used to identify all TBI-related emergency department (ED) visits, hospitalizations, and deaths that occurred in 1998 to children aged 0-19 years according to the Centers for Disease Control and Prevention's standard case definition and protocol. Inpatient admission was modeled as a function of patient, injury, and hospital characteristics. RESULTS: The overall incidence of pediatric TBI (i.e., ED visits, hospitalizations, and deaths) in 1998 was 670/100,000. After controlling for injury severity and other factors, uninsured children were 40% less likely to be hospitalized (95% CI = 0.43 to 0.82) and children with Medicaid were 90% more likely to be hospitalized (95% CI = 1.42 to 2.54) than were those with private insurance. The presence of a major associated injury significantly influenced the likelihood of hospitalization, especially among children with a minor (OR = 8.8) to moderate (OR = 11.6) TBI. Children who presented to a trauma center hospital were significantly more likely to be hospitalized than children treated at a non-trauma center hospital, although this varied depending on income (OR = 1.8 for high versus low) and hospital volume (OR = 2.6 for a small hospital and OR = 29.0 for a large hospital). CONCLUSIONS: After adjusting for TBI severity and the presence of associated injuries, significant differences in hospitalization rates may exist among different patient subgroups and hospitals for children who sustain TBIs.
Authors: M Katherine Henry; Joanne N Wood; Kristina B Metzger; Konny H Kim; Chris Feudtner; Mark R Zonfrillo Journal: J Pediatr Date: 2016-07-14 Impact factor: 4.406
Authors: Mark R Zonfrillo; Isabella Zaniletti; Matthew Hall; Evan S Fieldston; Jeffrey D Colvin; Jessica L Bettenhausen; Michelle L Macy; Elizabeth R Alpern; Gretchen J Cutler; Jean L Raphael; Rustin B Morse; Marion R Sills; Samir S Shah Journal: J Pediatr Date: 2015-11-10 Impact factor: 4.406