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Pediatrics

Research Snapshot Theater: Trauma, Pediatric I

(1756) Severe Pediatric TBI and Transport to a Quaternary Pediatric Facility: An Outcome Analysis

Tuesday, February 25, 2025
8:45am – 9:45am Eastern Time
Location: Connections Central - RST 03

    First Author(s)

  • Ayush Lacoul, MD (he/him/his)

    CAN

    • Co-Author(s)

  • EG

    Ellie Gabriel, MS

    Medical Student
    Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

  • AG

    April Giannotti, BS

    Clinical Data Analyst
    Division of Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, United States

  • NK

    Nankee Kumar, MD

    Medical Student
    Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

  • JK

    Jasleen Kaur, n/a

    Student
    Division of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, PA, United States

  • KS

    Kumaran Senthil, MD

    Assistant Professor of Anesthesiology and Critical Care
    Childrens Hospital of Philadelphia
    Philadelphia, PA, United States

  • Vanessa M. Mazandi, MD,

    Attending Physician
    Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
    Philadelphia, Pennsylvania, United States

  • CP

    Craig Press, MD, PhD

    Attending Physician and Medical Director of the Neuroscience Unit
    Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States

  • Matthew Kirschen, MD, PhD

    Assoicate Professor of Anesthesiology, Critical Care, and Pediatrics
    Childrens Hospital of Philadelphia
    Philadelphia, PA, United States

  • AT

    Alexis Topjian, MD, MSCE, FCCM

    Director, Neurocritical Care; Professor of Anesthesiology, Critical Care, and Pediatrics
    Childrens Hospital of Philadelphia
    Philadelphia, Pennsylvania, United States

  • CK

    Chong-Tae Kim, MD, PhD

    Attending Physician
    Division of Physical Medicine and Rehabilitation, Children’s Hospital of Philadelphia, Philadelphia, PA, United States

  • TK

    Todd J. Kilbaugh, MD

    Attending Physician and Medical Director of the ECMO Center
    Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA, United States

  • SC

    Shih-Shan Chen, MD

    Director of Vascular Neurosurgery and Associate Director with the Trauma Center
    Division of Neurosurgery, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

  • JH

    Jimmy W. Huh, MD

    Attending Physician
    Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

Introduction: Traumatic brain injury (TBI) are the leading cause of injury related death and neurologic morbidity in pediatrics. We hypothesized that due to longer transport time, inter-facility transport to a quaternary pediatric intensive care unit (PICU) will be associated with higher mortality and worse functional outcome assessed by Glasgow Outcome Scale-Extended (GOS-E) at discharge and at 6 months compared to direct transport from scene.

Methods: We conducted a retrospective analysis of pediatric patients ( < 18 years) admitted to a single quaternary PICU between 2015 to 2023 with severe TBI (Glasgow Coma Scale ≤ 8). Patients were grouped based on direct from scene vs. interfacility transport. Transport time was defined as time from initial dispatch call to the quaternary facility (via the field or referral hospital) to arrival time at our facility. Interventions administered pre-PICU admission were documented, and injury severity was controlled for using the Revised Trauma Score. We used univariate and multivariate regression analyses to assess outcomes.

Results: 72/680 admitted TBI patients met inclusion criteria for analysis. The average transport time was 1.49 hours, with direct and interfacility transport times averaging 0.65 hours and 2.05 hours, respectively (p < 0.01). The mortality rate for the direct group was 2/29 (6.9%) while interfacility was 9/43 (20.9%). The multivariate analysis of transport time by direct (p =0.673) or interfacility (p = 0.085) was not associated with mortality; however, younger age from an interfacility transport had a higher risk for mortality (p = 0.026). There were no significant differences in GOS-E scores between direct and interfacility transport groups at discharge (p =0.27) or 6 months (p =0.68), however, older children from interfacility transfer initially demonstrated better GOS-E at discharge (p = 0.029).

Conclusions: Interfacility transport to a quaternary pediatric care center was not associated with worse functional outcome or mortality compared to direct transport. However, younger children from interfacility transport had a higher risk for mortality and worse functional outcome. Further analysis of initial interventions prior to arrival at a quaternary PICU especially in the younger population are warranted.