Comparative analysis of outcomes in pediatric traumatic brain injury at urban teaching versus nonteaching hospitals across the United States.

BACKGROUND

Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children, and timely access to trauma centers is crucial for improving outcomes. Scarce research compares pediatric TBI outcomes between urban teaching and nonteaching hospitals. This study addresses this gap.

METHODS

We conducted a cross-sectional analysis of patients aged 0 to 17 years with TBI admitted to US urban hospitals from 2016 to 2021 using data from National Inpatient Sample database. Outcomes were in-hospital mortality, length of stay (LOS), and complications.

RESULTS

Of 28,674 TBI patients, 27,586 (96.2%) were admitted to teaching hospitals. These patients were younger (8.3 vs. 10.4 years, p  < 0.001), more likely to be Black (16.7% vs. 9.0%, p  < 0.001), and Medicaid insured (49.5% vs. 42.6%, p  < 0.001). Teaching hospitals had more referrals (29.2% vs. 13.1%, p  < 0.001) and more severely injured patients (Injury Severity Score, ≥25: 29.6% vs. 21.9%; p  < 0.001). Mortality was comparable across both settings as were most medical complications. Length of stay was longer (mean [SD], 5.9 [11.6] days vs. 4.3 [8.1] days; p  < 0.001), and deep venous thrombosis was marginally higher in teaching hospitals (1.0% vs. 0.3%, p  < 0.02). Adjusted models showed similar odds in mortality (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.69-1.61) and complications (OR, 0.96; 95% CI, 0.69-1.35) but longer LOS ( β coefficient, 0.85; 95% CI, 0.13-1.57) in teaching hospitals. Black and uninsured children had higher odds of death than Whites (OR, 1.41; 95% CI, 1.18-1.69) and Medicaid patients (OR, 1.70; 95% CI, 1.28-2.26) within teaching hospitals.

CONCLUSION

Teaching hospitals admitted more ill patients, had higher referrals, and higher patient volumes than nonteaching hospitals. While mortality and complications did not differ, LOS was longer in teaching hospitals. Notably, within teaching hospitals, Black and uninsured children had higher mortality. These findings highlight appropriate triaging in pediatric TBI care while also drawing attention to potential structural inequities that warrant urgent intervention. ( J Trauma Acute Care Surg . 2026;101: 442-450. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.).

LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.