Graves Janessa M, Lujan Silvia, Velonjara Julia L, Petroni Gustavo, Guadagnoli Nahuel, Bell Michael J, Vavilala Monica S
WWAMI Rural Health Research Center, Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America.
Washington State University College of Nursing, Spokane, Washington, United States of America.
PLOS Glob Public Health. 2025 May 8;5(5):e0004318. doi: 10.1371/journal.pgph.0004318. eCollection 2025.
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.
创伤性脑损伤（TBI）是全球儿童发病和死亡的主要原因。了解不同资源环境下严重TBI住院期间的医疗服务利用情况，对于改进临床实践、改善患者预后以及减轻TBI负担至关重要。我们研究了南美洲重症TBI儿童的医院服务利用情况。这项对实施严重TBI临床管理指南的随机对照试验基线期收集的数据进行的二次分析，确定了2019年9月1日至2020年7月13日期间阿根廷、智利和巴拉圭16家医院中患有严重TBI的儿科患者（<18岁）。收集了人口统计学、损伤特征、临床表现、重症监护病房（ICU）使用情况、手术干预和影像学数据，并计算了描述性统计数据。基于2019冠状病毒病大流行，在两个时间段内使用学生t检验和卡方检验检查了利用差异：大流行前（2019年9月1日至2020年3月10日）和大流行期间（2020年3月11日至7月13日）。在研究期间（n = 80例大流行前和n = 36例大流行期间），116例严重TBI患者（中位年龄：6.5岁）入组。两个时间段之间在人口统计学特征、损伤机制或出院结局方面没有差异。大流行期间血管加压药的使用（63.8%对33.3%，p < 0.01）和手术（p = 0.05）较少见。其他措施，包括营养、机械通气和中心静脉压监测随时间保持稳定。颅内压（ICP）监测一直保持在50%以上。我们未能检测到导致儿科严重TBI ICU护理或医院出院结局改变的大流行效应。临床医生成功地进行了调整。
