Differences in Care Practices and Outcomes for Adolescents With Severe TBI: Adult vs Pediatric Trauma Centers

Background: Adolescent trauma patients (ATPs) with traumatic brain injury (TBI) are a population with challenges to standardizing treatment practices and optimizing outcomes. Adult trauma centers (ATCs) and pediatric trauma centers (PTCs) may have different care practices and outcomes for ATPs with severe TBI. Methods: A retrospective analysis was performed querying the 2020-2022 Trauma Quality Improvement Program database, observing treatments and outcomes for ATPs aged 10-19 years old with head Abbreviated Injury Scale (AIS) 3-5 and TBI diagnosis. Multivariable logistic regression (MLR) was performed for tracheostomy, neurosurgical interventions, and mortality. Results: 28,527 ATPs were included in the study. 3,744 (13%) and 24,783 (87%) were treated at PTCs and ATCs, respectively. Most patients (73%) were male and had a blunt mechanism (89%). Patients at ATCs had lower Glasgow Coma Scale scores (p<.0001), higher head AIS scores (p<.0001), and higher mortality (10% vs 6%, p<.0001). Pediatric trauma centers utilized less venous thromboembolism (VTE) prophylaxis (32% vs 15%, p<.0001), which was evident across all ages 10-19, and had fewer VTE events (p=.001). Adult trauma centers were more likely to perform intracranial pressure monitoring, tracheostomy, long-term enteral access device (LTEAD), and craniotomy (all p<0.0001). Adult trauma centers had shorter median times to tracheostomy and LTEAD. Multivariable logistic regression for tracheostomy and neurosurgical interventions were associated with ATCs, after controlling for severity of TBI and other covariates. Both tracheostomy and neurosurgical interventions were less likely in the uninsured (p<.0001). Discussion: Care for ATPs with severe TBI varies between ATCs and PTCs. Pathways are needed to optimize outcomes for all ATPs with TBI.