Reduced hospitalisations for paediatric mild traumatic brain injury: a nationwide observational study.

Abstract

Objective: Traumatic brain injury (TBI) is common in childhood, with mild TBI (mTBI) predominating. Germany reports higher hospitalisation rates for paediatric TBI than any other country, suggesting overadmission of mild cases. The study objective was to determine TBI-related hospitalisations in patients <18 years from 2014 to 2020 and describe variability of TBI-related hospitalisations between emergency departments (EDs).

Design: Retrospective observational study using the German hospital dataset (GHD) and controlling data from 18 paediatric EDs.

Setting: Cases were identified from the GHD using International Classification of Diseases-10 codes and classified by severity using the Abbreviated Injury Scale for the head. Additionally, the proportion of inpatient versus outpatient TBI management from 18 paediatric EDs was assessed.

Patients: Cases with TBI as discharge diagnosis hospitalised in Germany (GHD) or presenting at a participating ED.

Interventions: N/A.

Main outcome measures: Standardised morbidity ratios (SMRs) for 2020 with 2014-2019 as reference period (GHD); proportion of hospitalisations of TBI patients per ED.

Results: Among 618 577 TBI cases, mean annual TBI hospitalisations declined from 91 299±1656 (mean±SD) cases in 2014-2019 to 70 783 in 2020. SMRs for all-cause admissions (0.83 (95% CI 0.81 to 0.85)) and mTBI (0.75 (95% CI 0.73 to 0.78)) decreased more strongly than for moderate and severe TBI (0.95 (95% CI 0.91 to 0.99) and 0.95 (95% CI 0.90 to 1.01)). Hospitalisation rates in EDs ranged from 19.1% to 93.0% (median: 75.0%).

Conclusions and relevance: The disproportionate reduction of mTBI hospitalisations during the COVID-19 pandemic compared with moderate to severe cases suggests that there is potential for safely managing more mild cases in outpatient settings.