Outcomes of children with serious traumatic brain injury treated in pediatric vs. adult departments

The impact of treatment in a non-pediatric department on mortality and outcomes of children with traumatic brain injury (TBI) is unknown. This study aimed to quantify the impact of the treating department (pediatric (PD) or adult (AD)) on in-hospital case fatality and functional short-term outcomes in children with serious TBI who survived the initial 12 hours after hospital admission. A Nationwide retrospective cohort study was conducted from a dataset that comprises all discharges from German hospitals from 2016 to 2021. Disease and procedural codes were used to retrieve clinical and outcome information. Hierarchical multilevel logistic regression modeling was performed to quantify the effect of the treating department on the outcomes of interest. Eligibility criteria were age < 18 years and hospital admission with serious TBI. The main outcome was in-hospital death and secondary outcomes were pediatric complex chronic conditions category (PCCC) [&ge;] 2 in survivors, composite outcome (death or PCCC [&ge;] 2), and adjusted mean PCCC in survivors. Of 13,492,528 pediatric cases, 12,275 were included. The adjusted odds ratio (OR) for death was 3.00 (95 % confidence interval 1.93-4.68) for children treated in ADs compared to PDs. The OR for PCCC [&ge;] 2 was 0.93 (0.78-1.12) and 1.04 (0.87-1.25) for the composite outcome. Adjusted average PCCC were 0.40 (0.37-0.44) in ADs and 0.44 (0.42-0.46) in PDs. This comprehensive nationwide study found increased odds for in-hospital death but similar functional outcomes at discharge among surviving children with serious TBI who were treated outside of PDs.