Pediatric Head Injury in the Delaware Trauma System: Toward Improved Calibration of Severity and Resource Utilization.

Background: How the existence of trauma systems affects the care of less severely injured patients has received little attention.

Objective: The current study examines the longitudinal effect on the care of children with traumatic brain injuries (TBIs) of the incorporation of a pediatric trauma center into a regional trauma system.

Methods: The Delaware Trauma System provided registry data from 2000 to 2014. Inclusion criteria were age less than 18 years and ICD9 diagnostic coding for any head injury. Admissions were assessed as "substantial" or "non-substantial" based on study criteria. We hypothesized a step-wise increase in registrations of mild TBI and non-substantial admissions coinciding with the opening of Delaware's pediatric trauma center in late 2006.

Results: There were 5,272 registrations. Before the opening of the pediatric trauma center, 1,737 of 2,038 (85.2 percent) head injuries were mild; afterwards mild TBI accounted for 2,894 of 3,230 registrations (89.6 percent; odds ratio 1.49, 95 percent Cl 1.26 - 1.76; p < 0.0001). Before the opening, 850 of 2,038 (41.7 percent) encounters were categorized as non-substantial; afterwards 1,528 of 3,230 admissions (47.3 percent) were non-substantial (odds ratio 1.25; 95 percent C 1.12 - 1.40; p < 0.0001). Inter-hospital transports within the system exhibited similar trends.

Conclusions: Registrations of mild TBI and non-substantial admissions trended upward steadily during the years of this study with a suggestive step-wise increase correlating with the opening of a pediatric trauma center. Guidelines are needed to facilitate management of patients with minor injuries at the lowest appropriate level of care.