U.S. Trends of ED Visits for Pediatric Traumatic Brain Injuries: Implications for Clinical Trials
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources
2.2. Definition of Pediatric TBI
2.3. Definition of Pediatric Concussion
2.4. Definition of Pediatric Severe TBI
2.5. Definition of TBI Type
2.6. Study Variables
2.7. Statistical Analysis
2.8. Bootstrap Simulation Analysis
3. Results
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Year | Pediatric ED Visits | Pediatric TBI (Including Code 959.01) 2 | Pediatric TBI (Excluding Code 959.01) | Pediatric Concussion | Pediatric Severe TBI | |||||
---|---|---|---|---|---|---|---|---|---|---|
Weighted Number | % Change 3 | Weighted Number | % Change | Weighted Number | % Change | Weighted Number | % Change | Weighted Number | % Change | |
2006 | 26,421,966 | 0.0 | 624,705 | 0.0 | 216,097 | 0.0 | 162,013 | 0.0 | 34,046 | 0.0 |
2007 | 26,952,590 | 2.0 | 638,088 | 2.1 | 224,657 | 4.0 | 168,717 | 4.1 | 35,311 | 3.7 |
2008 | 26,422,740 | 0.0 | 656,897 | 5.2 | 231,665 | 7.2 | 177,039 | 9.3 | 35,324 | 3.8 |
2009 | 28,411,936 | 7.5 | 798,044 | 27.7 | 243,015 | 12.5 | 193,538 | 19.5 | 31,893 | −6.3 |
2010 | 25,511,069 | −3.4 | 778,138 | 24.6 | 252,566 | 16.9 | 202,681 | 25.1 | 31,777 | −6.7 |
2011 | 27,010,706 | 2.2 | 851,405 | 36.3 | 255,072 | 18.0 | 209,917 | 29.6 | 28,575 | −16.1 |
2012 | 27,877,600 | 5.5 | 905,225 | 44.9 | 272,004 | 25.9 | 228,424 | 41.0 | 27,620 | −18.9 |
2013 | 26,596,325 | 0.7 | 837,428 | 34.1 | 262,826 | 21.6 | 218,984 | 35.2 | 27,787 | −18.4 |
Total | 215,204,932 | 6,089,930 | 1,957,902 | 1,561,313 | 252,333 |
Pediatric TBI Including 959.01 2 (n = 837,428) | Pediatric TBI Excluding 959.01 2 (n = 262,826) | Pediatric Concussion (n = 218,984) | Pediatric Severe TBI (n = 12,370) | ||
---|---|---|---|---|---|
Gender, weighted % (95% CI) 3 | |||||
Male | 61.2 (60.9–61.5) | 64.09 (63.6–64.6) | 64.0 (63.4–64.5) | 66.2 (64.4–68.1) | |
Female | 38.9 (38.6–39.1) | 35.9 (35.4–36.4) | 36.0 (35.5–36.6) | 33.8 (31.9–35.6) | |
Age (years), weighted % (95% CI) | |||||
Age 0– | 9.7 (9.2–10.1) | 5.3 (4.6–6.1) | 1.5 (1.3–1.7) | 20.9 (18.3–23.4) | |
Age 1–4 | 29.0 (28.3–29.6) | 13.7 (12–14.7) | 11.8 (10.9–12.7) | 19.7 (18.0–21.4) | |
Age 5–9 | 19.2 (18.9–19.5) | 16.5 (16–17.1) | 16.6 (16.0–17.2) | 15.3 (13.8–16.9) | |
Age 10–14 | 23.0 (22.5–23.6) | 33.7 (32–34.6) | 36.9 (35.9–37.8) | 19.5 (17.5–21.6) | |
Age 15–17 | 19.1 (18.4–19.9) | 30.8 (29–32.3) | 33.2 (32.0–34.4) | 24.5 (20.3–28.8) | |
TBI Type, weighted % (95% CI) | |||||
Type 1 | 9.9 (8.5–11.4) | 9.9 (8.5–11.4) | 0.2 (0.1–0.2) | 88.0 (86.5–89.5) | |
Type 2 | 85.6 (83.8–87.5) | 85.6 (83.8–87.5) | 99.8 (99.8–99.9) | 4.6 (3.7–5.5) | |
Type 3 | 4.4 (3.8–5.0) | 4.4 (3.8–5.0) | - | 7.4 (6.3–8.5) | |
ISS, weighted % (95% CI) | |||||
ISS 1–3 | 3.1 (2.9–3.3) | 9.9 (9.3–10.6) | 11.0 (10.2–11.7) | - | |
ISS 4–8 | 92.5 (91.8–93.1) | 77.5 (75.8–79.1) | 87.1 (86.3–87.9) | - | |
ISS 9–15 | 2.9 (2.6–3.3) | 7.9 (6.9–8.9) | 1.6 (1.5–1.8) | - | |
ISS 16–24 | 1.3 (1.1–1.4) | 3.9 (3.4–4.4) | 0.3 (0.2–0.4) | 84.3 (82.3–86.3) | |
ISS 25–75 | 0.2 (0.2–0.3) | 0.7 (0.6–0.9) | 0.1 (0.0–0.1) | 15.7 (13.7–17.7) | |
Major external cause, weighted % (95% CI) | |||||
Fall | 47.8 (46.2–49.4) | 38.3 (36.7–40.0) | 37.0 (35.5–38.5) | 30.9 (28.4–33.4) | |
Struck | 30.0 (29.0–31.1) | 34.1 (32.6–35.6) | 38.1 (36.7–39.5) | 10.0 (8.7–11.4) | |
Motor vehicle crash | 6.6 (6.2–6.9) | 8.4 (7.8–9.0) | 7.3 (6.8–7.8) | 26.7 (23.7–29.8) | |
Patient location, weighted % (95% CI) | |||||
Large central metropolitan | 27.0 (22.7–31.2) | 22.7 (18.0–27.5) | 21.7 (17.0–26.3) | 23.7 (18.2–29.3) | |
Large fringe metropolitan | 25.7 (22.1–29.3) | 26.0 (22.3–29.7) | 26.9 (23.1–30.8) | 20.9 (15.7–26.2) | |
Medium metropolitan | 22.1 (18.9–25.4) | 21.6 (18.3–24.9) | 21.6 (18.4–24.9) | 21.6 (16.7–26.5) | |
Small metropolitan | 8.4 (6.7–10.2) | 9.0 (7.2–10.8) | 8.9 (7.0–10.9) | 10.1 (7.8–12.4) | |
Micropolitan | 11.0 (9.8–12.1) | 12.4 (11.2–13.7) | 12.5 (11.1–13.8) | 14.7 (12.2–17.2) | |
Not metropolitan or micropolitan | 5.8 (5.2–6.5) | 8.2 (7.3–9.2) | 8.3 (7.3–9.4) | 8.9 (7.2–10.7) | |
Primary expected payer, weighted % (95% CI) | |||||
Medicare | 0.4 (0.1–0.6) | 0.4 (0.1–0.6) | 0.3 (0.1–0.5) | 0.3 (0.0–0.5) | |
Medicaid | 43.1 (41.4–44.9) | 35.9 (34.1–37.7) | 33.7 (32.1–35.3) | 46.3 (42.2–50.3) | |
Private including HMO | 46.3 (44.5–48.2) | 54.0 (52.0–55.9) | 56.1 (54.4–58.1) | 43.0 (39.0–47.1) | |
Self-pay | 5.7 (5.4–6.1) | 5.2 (4.8–5.6) | 5.3 (4.8–5.7) | 4.2 (3.4–5.0) | |
No charge | 0.0 (0.0–0.1) | 0.1 (0.0–0.1) | 0.1 (0.0–0.1) | 0.1 (0.0–0.2) | |
Other | 4.4 (3.6–5.2) | 4.5 (3.8–5.2) | 4.3 (3.7–5.0) | 6.2 (3.5–8.8) | |
Children’s hospital, weighted % (95% CI)4 | |||||
No | 92.3 (86.2–98.4) | 89.1 (80.6–97.6) | 90.9 (83.3–98.5) | 80.2 (65.9–94.4) | |
Yes | 7.7 (1.6–13.8) | 10.9 (2.4–19.4) | 9.1 (1.5–16.7) | 19.8 (5.6–34.1) | |
Trauma center level designation, weighted % (95% CI) | |||||
Non-trauma center | 37.8 (34.1–41.5) | 36.6 (32.2–41.0) | 39.5 (35.1–43.9) | 16.4 (12.7–20.2) | |
Trauma center level I | 20.6 (15.0–26.2) | 24.9 (17.7–32.1) | 20.2 (13.5–26.9) | 53.8 (45.0–62.6) | |
Trauma center level II | 10.9 (8.8–13.0) | 10.3 (8.2–12.4) | 10.4 (8.4–12.4) | 11.9 (8.2–15.7) | |
Trauma center level III | 8.4 (6.8–9.9) | 8.7 (6.9–10.5) | 9.2 (7.3–11.2) | 5.2 (3.8–6.6) | |
Non-trauma or trauma center level III, collapsed category | 17.1 (14.9–19.4) | 14.7 (12.2–17.3) | 16.0 (13.2–18.7) | 7.2 (5.7–8.8) | |
Trauma center level I or II, collapsed category | 5.2 (3.6–6.9) | 4.8 (3.4–6.1) | 4.8 (3.5–6.0) | 5.5 (3.8–7.1) | |
Hospital urban-rural designation, weighted % (95% CI) | |||||
Large metropolitan areas with at least 1 million residents | 49.6 (45.3–54.0) | 46.4 (40.8–52.0) | 45.1 (39.8–50.5) | 51.4 (42.1–60.8) | |
Small metropolitan areas with less than 1 million residents | 29.7 (26.1–33.3) | 30.9 (26.4–35.4) | 30.5 (26.6–34.4) | 35.4 (26.0–44.7) | |
Micropolitan areas | 10.1 (8.7–11.4) | 10.4 (8.8–11.9) | 11.2 (9.6–12.9) | 5.4 (4.1–6.6) | |
Not metropolitan or micropolitan | 4.6 (3.9–5.3) | 6.6 (5.6–7.7) | 7.3 (6.1–8.4) | 2.4 (1.9–2.9) | |
Collapsed category of small metropolitan and micropolitan | 2.5 (1.5–3.5) | 2.2 (1.5–3.0) | 2.2 (1.4–3.0) | 2.7 (1.5–4.0) | |
Metropolitan, collapsed category of large and small metropolitan | 2.8 (1.2–4.3) | 2.4 (1.1–3.7) | 2.5 (1.1–3.9) | 1.4 (0.6–2.2) | |
Non-metropolitan, collapsed category of micropolitan and rural | 0.8 (0.5–1.1) | 1.1 (0.8–1.5) | 1.2 (0.8–1.6) | 1.3 (0.7–1.8) | |
Control/ownership of hospital, weighted % (95% CI) | |||||
Government or private, collapsed category | 68.9 (65.8–72.0) | 69.3 (65.5–73.1) | 67.0 (63.2–71.0) | 84.2 (81.1–87.4) | |
Government, nonfederal, public | 5.5 (4.5–6.6) | 5.9 (4.7–7.1) | 6.4 (5.1–7.7) | 2.9 (2.2–3.7) | |
Private, non-profit, voluntary | 16.0 (13.8–18.3) | 14.9 (12.2–17.6) | 16.0 (13.1–18.9) | 7.6 (6.0–9.3) | |
Private, invest-own | 6.6 (5.5–7.7) | 5.7 (4.6–6.7) | 6.1 (5.0–7.2) | 3.3 (2.4–4.1) | |
Private, collapsed category | 3.0 (2.5–3.5) | 4.2 (3.4–5.0) | 4.6 (3.7–5.4) | 1.9 (1.3–2.5) | |
Region of hospital in US, weighted % (95% CI) | |||||
Northeast | 20.6 (17.5–23.8) | 19.4 (16.0–22.7) | 20.8 (17.3–24.4) | 10.4 (6.8–13.9) | |
Midwest | 22.9 (18.8–27.0) | 25.3 (19.8–30.7) | 25.7 (20.3–31.1) | 23.2 (15.6–30.8) | |
South | 33.6 (29.7–37.5) | 31.9 (27.5–36.2) | 31.4 (27.3–35.4) | 36.8 (28.3–45.2) | |
West | 22.9 (19.0–26.7) | 23.5 (18.2–28.9) | 22.1 (17.9–26.3) | 29.6 (19.3–39.9) | |
Teaching status of hospital, weighted % (95% CI) | |||||
Metropolitan non-teaching | 39.8 (36.0–43.5) | 36.2 (31.8–40.5) | 38.5 (34.2–42.8) | 21.2 (16.9–25.5) | |
Metropolitan teaching | 44.8 (40.2–49.4) | 45.7 (40.0–51.5) | 41.8 (36.3–47.4) | 69.7 (63.8–75.6) | |
Non-metropolitan | 15.5 (13.7–17.2) | 18.1 (15.8–20.4) | 19.7 (17.3–22.0) | 9.1 (7.1–11.0) |
Hospital Classification | No. of Hospitals in NEDS 2013 | No. of Hospitals Selected | Number of Pediatric TBIs (Excluding 959.01) 1 | Number of Pediatric Concussions | Number of Severe Pediatric TBIs | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Median | P5–P95 2 | Median | P5–P95 2 | Median | P5–P95 2 | |||||||||
TBI ED visits > 500 | 408 | 5 | 457 | (202 | – | 1435) | 396 | (172 | – | 976) | 37 | (11 | – | 291) |
TBI ED visits > 500 | 408 | 10 | 960 | (526 | – | 2429) | 813 | (465 | – | 1769) | 84 | (33 | – | 396) |
TBI ED visits > 1000 | 211 | 5 | 694 | (355 | – | 2104) | 571 | (293 | – | 1503) | 67 | (22 | – | 330) |
TBI ED visits > 1000 | 211 | 10 | 1429 | (847 | – | 3180) | 1183 | (719 | – | 2651) | 164 | (63 | – | 504) |
Trauma center I | 49 | 5 | 1,184 | (389 | – | 3115) | 774 | (259 | – | 2334) | 251 | (67 | – | 651) |
Trauma center I | 49 | 10 | 2493 | (1171 | – | 5190) | 1613 | (790 | – | 3778) | 522 | (209 | – | 1055) |
Trauma center II | 46 | 5 | 657 | (394 | – | 1181) | 556 | (329 | – | 979) | 71 | (29 | – | 161) |
Trauma center II | 46 | 10 | 1352 | (889 | – | 2067) | 1144 | (753 | – | 1717) | 147 | (79 | – | 271) |
Pediatric hospital | 6 | 5 | 4496 | (2496 | – | 6876) | 3165 | (1691 | – | 5376) | 861 | (442 | – | 1270) |
Adult hospital | 928 | 5 | 236 | (70 | – | 645) | 208 | (59 | – | 545) | 17 | (3 | – | 102) |
Adult hospital | 928 | 10 | 507 | (221 | – | 1040) | 431 | (190 | – | 870) | 39 | (12 | – | 179) |
Teaching hospital | 184 | 5 | 527 | (177 | – | 2108) | 424 | (149 | – | 1700) | 59 | (13 | – | 354) |
Teaching hospital | 184 | 10 | 1151 | (510 | – | 2961) | 904 | (414 | – | 2335) | 153 | (39 | – | 538) |
Non-teaching hospital | 363 | 5 | 265 | (18 | – | 1244) | 215 | (14 | – | 836) | 18 | (5 | – | 60) |
Non-teaching hospital | 363 | 10 | 544 | (82 | – | 2011) | 425 | (64 | – | 1440) | 37 | (17 | – | 105) |
Northeast region | 121 | 5 | 378 | (142 | – | 880) | 339 | (129 | – | 765) | 17 | (4 | – | 98) |
Northeast region | 121 | 10 | 788 | (395 | – | 1439) | 705 | (352 | – | 1299) | 37 | (14 | – | 138) |
Midwest region | 278 | 5 | 186 | (56 | – | 649) | 159 | (50 | – | 497) | 12 | (2 | – | 117) |
Midwest region | 278 | 10 | 404 | (163 | – | 2087) | 348 | (145 | – | 1763) | 30 | (8 | – | 204) |
Southern region | 358 | 5 | 220 | (62 | – | 837) | 189 | (55 | – | 633) | 18 | (4 | – | 140) |
Southern region | 358 | 10 | 484 | (204 | – | 1295) | 411 | (172 | – | 959) | 42 | (12 | – | 294) |
Western region | 183 | 5 | 278 | (89 | – | 1348) | 243 | (80 | – | 868) | 23 | (5 | – | 306) |
Western region | 183 | 10 | 590 | (250 | – | 1759) | 508 | (223 | – | 1174) | 52 | (16 | – | 357) |
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Chen, C.; Shi, J.; Stanley, R.M.; Sribnick, E.A.; Groner, J.I.; Xiang, H. U.S. Trends of ED Visits for Pediatric Traumatic Brain Injuries: Implications for Clinical Trials. Int. J. Environ. Res. Public Health 2017, 14, 414. https://doi.org/10.3390/ijerph14040414
Chen C, Shi J, Stanley RM, Sribnick EA, Groner JI, Xiang H. U.S. Trends of ED Visits for Pediatric Traumatic Brain Injuries: Implications for Clinical Trials. International Journal of Environmental Research and Public Health. 2017; 14(4):414. https://doi.org/10.3390/ijerph14040414
Chicago/Turabian StyleChen, Cheng, Junxin Shi, Rachel M. Stanley, Eric A. Sribnick, Jonathan I. Groner, and Henry Xiang. 2017. "U.S. Trends of ED Visits for Pediatric Traumatic Brain Injuries: Implications for Clinical Trials" International Journal of Environmental Research and Public Health 14, no. 4: 414. https://doi.org/10.3390/ijerph14040414