Journal of neurosurgery. Pediatrics · 2023
Association between hospital volume and in-hospital mortality in pediatric severe traumatic brain injury: a nationwide retrospective observational study in Japan.
Наблюдательное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Utsumi Shu, Ohki Shingo, Ueda Takeshi, Amagasa Shunsuke, Nishikimi Mitsuaki, Shime Nobuaki
Аннотация
OBJECTIVE: The objective of this study was to investigate the association between hospital volume and in-hospital mortality in pediatric patients with severe traumatic brain injury (TBI).
METHODS: This retrospective cohort study used data from the Japan Trauma Data Bank between 2010 and 2018, specifically those of pediatric patients with severe TBI (Glasgow Coma Scale [GCS] score < 9 and head Abbreviated Injury Scale score > 2). Hospital volume was defined as the number of pediatric patients with severe TBI throughout the study period. Hospital volume was categorized as low (reference category: 1-9 patients), middle (10-17 patients), or high (> 18 patients) volume. Multivariate mixed-effects logistic regression analysis was performed to determine the association between hospital volume categories and in-hospital mortality. Subgroup analyses were performed using data on craniotomy and the presence of severe torso injuries. In the sensitivity analyses, patients with a GCS score of 3, interhospital transfer, and major intensive care unit complications were excluded.
RESULTS: A total of 1148 pediatric patients with severe TBI, with a median age of 12 years (IQR 7-16 years), treated at 141 hospitals were included. In total, 236 patients (20.6%) died in the hospital. Multivariate analysis showed no significant association between hospital volume and in-hospital mortality (high volume: OR 1.15, 95% CI 0.80-1.64; middle volume: OR 0.89, 95% CI 0.62-1.26). Subgroup and sensitivity analyses showed similar results.
CONCLUSIONS: Hospital volume may not be associated with in-hospital mortality in pediatric patients with severe TBI.
METHODS: This retrospective cohort study used data from the Japan Trauma Data Bank between 2010 and 2018, specifically those of pediatric patients with severe TBI (Glasgow Coma Scale [GCS] score < 9 and head Abbreviated Injury Scale score > 2). Hospital volume was defined as the number of pediatric patients with severe TBI throughout the study period. Hospital volume was categorized as low (reference category: 1-9 patients), middle (10-17 patients), or high (> 18 patients) volume. Multivariate mixed-effects logistic regression analysis was performed to determine the association between hospital volume categories and in-hospital mortality. Subgroup analyses were performed using data on craniotomy and the presence of severe torso injuries. In the sensitivity analyses, patients with a GCS score of 3, interhospital transfer, and major intensive care unit complications were excluded.
RESULTS: A total of 1148 pediatric patients with severe TBI, with a median age of 12 years (IQR 7-16 years), treated at 141 hospitals were included. In total, 236 patients (20.6%) died in the hospital. Multivariate analysis showed no significant association between hospital volume and in-hospital mortality (high volume: OR 1.15, 95% CI 0.80-1.64; middle volume: OR 0.89, 95% CI 0.62-1.26). Subgroup and sensitivity analyses showed similar results.
CONCLUSIONS: Hospital volume may not be associated with in-hospital mortality in pediatric patients with severe TBI.