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Paediatric traumatic brain injury severity and acute care costs
  1. Sonia Singh1,2,
  2. Franz E Babl1,3,
  3. Li Huang4,
  4. Stephen Hearps5,
  5. John Alexander Cheek1,6,
  6. Jeffrey S Hoch7,8,
  7. Vicki Anderson9,10,
  8. Kim Dalziel4,11
  1. 1Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
  2. 2Emergency Medicine, University of California Davis Medical Center, Sacramento, California, USA
  3. 3Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  4. 4School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  5. 5Child Neuropsychology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  6. 6Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  7. 7Department of Public Health Sciences, University of California Davis, Davis, California, USA
  8. 8Center for Healthcare Policy and Research, University of California Davis Health System, Sacramento, California, USA
  9. 9Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  10. 10Department of Psychology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  11. 11Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  1. Correspondence to Dr Sonia Singh, Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, VIC 3010, Australia; singhsd{at}student.unimelb.edu.au

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What is already known?

  • Traumatic brain injury is the leading cause of disability worldwide.

  • Falls are the most common cause of traumatic brain injuries in children.

What this study adds?

  • Transportation-related and suspected non-accidental injuries increase the average acute costs of mild traumatic brain injuries in children.

  • Falls and sports-related injuries lower the average acute costs of moderate and severe traumatic brain injuries in children.

INTRODUCTION

Traumatic brain injury (TBI) in children is the leading cause of disability and is associated with a significant burden of disease globally.1 Population-based studies reporting the incidence of TBI in Australia have focused on hospitalised patients.2 Most paediatric head trauma results in mild TBIs that do not require hospitalisation.1 In Australia, a 13% increase in emergency department (ED) presentations for paediatric head injuries were reported between 2014 and 2018.3

The most common mechanisms of head injuries are falls for children less than 11 years and transportation-related injuries for children 11 to 16 years.2 While falls are the most common mechanism of head injury in children and can be associated with the most long-term costs, transportation-related TBIs incur high acute care costs, with pedestrian injuries having the highest mean per-patient cost.2 3 This research estimates the effect of mechanisms of injury and severity on the acute care costs of TBI in children.

Methods

A planned subanalysis of children <18 years enrolled in the prospective multicentre Australasian Paediatric Head Injury Study (APHIRST) between 2011 and 2014. The study was designed to validate clinical decision rules for the diagnosis of TBI in children.4 The eight participating sites were all government-funded large tertiary hospitals.

The standard definition of acute care was used, including emergency presentations with discharge and acute admissions until hospital discharge. Common mechanisms of head injuries were identified a priori and were recorded at the time of patient enrolment …

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Footnotes

  • Twitter @SoniaSinghPEM, @KimCreatif

  • Contributors SS conceptualised and designed the study, acquired the cost data, conducted the analysis, wrote the first draft of the manuscript, and reviewed and revised the manuscript. FEB conceptualised and designed the APHIRST study, coordinated and supervised data collection, contributed to data interpretation, and critically reviewed and revised the manuscript. SJCH had full access to the APHIRST data, analysed the data, contributed to data interpretation, and critically reviewed and revised the manuscript. LH, JSH, JAC, VA and KD contributed to the interpretation of the data, and reviewed and revised the article critically. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The work was supported by grants from the National Health and Medical Research Council (project grant GNT1046727, Centre of Research Excellence for Paediatric Emergency Medicine GNT1058560), Canberra, Australia; the Murdoch Children's Research Institute, Melbourne, Australia (no award/grant number); the Emergency Medicine Foundation (EMPJ-11162), Brisbane, Australia; Perpetual Philanthropic Services (2012/1140), Australia; Auckland Medical Research Foundation (No. 3112011) and the A+ Trust (Auckland District Health Board), Auckland, New Zealand (no award/grant number); WA Health Targeted Research Funds 2013, Perth, Australia (no award/grant number); the Townsville Hospital and Health Service Private Practice Research and Education Trust Fund, Townsville, Australia (no award/grant number); and supported by the Victorian Government's Infrastructure Support Program, Melbourne, Australia (no award/grant number). SS was supported by an Australian Government Research Training Program Scholarship and a PREDICT CRE Research Higher Degree scholarship. FEB's time was partly funded by a grant from the Royal Children's Hospital Foundation and the Melbourne Campus Clinician Scientist Fellowship, Melbourne, Australia, and an NHMRC Practitioner Fellowship, Canberra, Australia.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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