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003. Pediatric Cranial Neurotrauma Care In High Income and Low-Middle Income Academic Centers: A Comparison of Demographics, Management, and Outcomes

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Authors: Ann-Christine Duhaime, MD, FAANS

Introduction:
Pediatric cranial trauma is the leading cause of acquired death and disability in children worldwide. However, trauma resources vary widely among global settings. We sought to compare demographics, management, and outcomes between a Level 1 Pediatric Trauma Center in the U.S and a tertiary referral hospital in a low-to-middle-income country to assess whether system and resource differences might influence availability of care and outcomes.Methods: We compared data from 214 pediatric head trauma admissions to Philippines General Hospital (Manila) with 139 children from the TRACK TBI Pediatrics study cohort from a U.S. academic medical center. The latter underwent brain imaging on clinical grounds as a condition of enrollment, and admitted patients were compared to the Philippine cohort regarding demographics, mechanism of injury, times to neurosurgical consult, imaging, and surgery, in-hospital mortality, and length of stay.
Results:
Age and gender distributions were similar with mean age about 9 years and 2/3 male. More children had positive imaging studies in the Philippine cohort (91% vs. 74%, n=306), and more underwent surgery (27% vs. 4%). Time to consult, time to imaging, and time to surgery were longer in the Philippines (11.0 vs. 4.8; 11.8 vs. 2.6; 76.8 vs. 5.5 hours, respectively). Most children survived in both groups, but in-hospital mortality was higher in the Philippine cohort (3% vs. 0%, p=.09), and length of stay was significantly longer (5 vs. 2 days, p < 0.001), likely reflecting higher severity of injury.
Conclusion:
Trauma care resources vary around the world, and patients brought to the hospital may have more severe injuries with higher mortality in more resource-limited settings. Time to care, imaging, and surgery is significantly longer. Access to prompt care through trauma system implementation may be a target for intervention to improve pediatric population health in low and middle-income countries. (Note: Drs. Rolle and Pascual served as co-first authors.)