Pediatric severe TBI in South America: Healthcare resource utilization before and during the COVID-19 pandemic.

Abstract

Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality worldwide. Understanding healthcare utilization during hospitalization for severe TBI across varied resource settings is crucial for informing improvements in clinical practice, patient outcomes, and for reducing TBI burden. We examined hospital services utilization among children with severe TBI in South America. This secondary analysis of data collected during the baseline period of a randomized controlled trial implementing severe TBI clinical management guidelines identified pediatric patients (<18 years) with severe TBI across 16 hospitals in Argentina, Chile, and Paraguay between September 1, 2019 and July 13, 2020. Demographics, injury characteristics, clinical presentation, intensive care unit (ICU) utilization, surgical interventions, and imaging data were collected, and descriptive statistics were calculated. Utilization differences were examined across two time periods based on the COVID-19 pandemic: prepandemic (September 1, 2019-March 10, 2020) and during the pandemic (March 11-July 13, 2020) using Student's t-tests and chi-square tests. One-hundred and sixteen patients (median age: 6.5 years) with severe TBI enrolled during the study (n = 80 prepandemic and n = 36 during the pandemic) period. There were no differences in demographic characteristics, injury mechanism, or discharge outcomes between time periods. Vasopressor use was less common during the pandemic (63.8% vs. 33.3%, p < 0.01) as were surgeries (p = 0.05). Other measures, including nutrition, mechanical ventilation, and central venous pressure monitoring were stable over time. Intracranial pressure (ICP) monitoring remained above 50% throughout. We failed to detect a pandemic effect resulting in pediatric severe TBI ICU care or hospital discharge outcome changes. Clinicians adapted successfully.