NS01 - Clinical Outcome Differences Between Adult and Pediatric Patients with Severe Traumatic Brain Injury

Introduction/Purpose: Traumatic brain injury (TBI) is one of the leading causes of death and disability among both children and adults. In 2017, approximately 224,000 people in the United States experienced TBI, with 7.8% being children and the rest being adults. Although severe TBI (defined as a Glasgow Coma Scale (GCS) of 8 or lower) accounts for a small portion of all TBI cases, patients who experience severe TBI tend to have worse outcomes. There are few articles, with varied results, that discuss the outcomes between adults and children who experienced severe TBI. In this study, we seek to examine the characteristics of the adult and pediatric population with severe TBI and compare the clinical outcomes between these two patient populations.

Methods or Case Description: Using the 2014 - 2016 National Trauma databank, we identified pediatric patients (ages 18 and below) and adult patients (ages 19 and above) who were admitted to hospitals in the United States for severe TBI. The demographics (age, gender, mechanism of injury), GCS scores, injury severity score and abbreviated injury scale (ISS AIS), and clinical outcomes (in-hospital complications, OR complications, ICU complications, mortality rate, highest in-hospital GCS total and motor score, ICU length of stay (LOS), hospital LOS, ventilator days, and hospital disposition) of the pediatric and adult TBI population were compared. The Student’s t-test was utilized for continuous data and Fisher’s exact test was utilized for categorical data using GraphPad Prism 7.04. Univariate and multivariate regression analysis was performed using RStudio 1.4.1717. A p-value< 0.05 was used as the threshold of statistical significance.

Outcomes: 10031 adult severe TBI patients and 4671 pediatric severe TBI patients were included in the analysis. Most of the patients were male, with there being a higher percentage of pediatric female patients than adult female patients (32.11% vs 26.87%, P<0.0001). There were no differences in the initial ISS AIS scores between pediatric and adult patients (25.27 ± 0.2012 vs2 5.3 ± 0.1357, P=0.9017), while pediatric patients had slightly higher GCS scores in the ED compared to adult patients (4.048 ± 0.02481 vs 3.827 ± 0.01552, P<0.0001). There were significant differences in mechanism of injury between pediatric and adult patients, with falls being the most common in adults (33.07%) and motor vehicle collisions as the most common in pediatric patients (38.13%). Mortality rate was higher in adults compared to children (54.94% vs 23.79%, P<0.0001), although children had longer hospital LOS (17490 ± 304.7 vs 7561 ± 106.5, P<0.0001), more ICU days (8.358 ± 0.1403 vs 4.31 ± 0.05175, P< 0.0001), and more ventilator days (6.117 ± 0.1162 vs 3.529 ± 0.04386, P<0.0001). There were significant differences in hospital disposition between pediatric patients and adults, with the most common disposition being home for children (35.99%) and death for adults (54.94%). Children tend to have more unplanned ICU complications, unplanned OR complications, UTI complications, decubitus complications, DVT complications, pneumonia complications, and surgical site infection complication, while adults had more cardiac arrest and myocardial infarction complications. After adjusting for gender, mechanism of injury, ISS AIS score, and GCS in ED, age is a significant predictor of ICU days (P<0.0001, R² = 0.0833) hospital LOS (P<0.0001, R² = 0.1013), and ventilator days (P<0.0001, R² = 0.0655).

Conclusion: The demographics of pediatric and adult patients with severe TBI differ, with higher percentage of females in the pediatric population and different distributions of mechanisms of injury between these two populations. Although children with severe TBI had longer ICU and hospital stays and different types of in-hospital complications, they also had better outcomes compared to adults, with significantly lower mortality rates and better discharge dispositions. These results suggest that even though children may take longer to recover from severe TBI, they tend to have better survival rates. This can possibly be attributed to fewer comorbidities and less frailty in children. The differences in anatomy and physiology between adults and children may also play a role in these differences in outcomes. Further studies need to be conducted to better elucidate the causes of these observed differences in these two patient populations.