1194: Regional Variations in Characteristics, Management, and Outcomes in Us Pediatric Severe Tbi

Introduction: Regional variations exist and affect many pediatric conditions. This study evaluates the impact of regional variations on presentation, management, and outcomes in children with severe TBI (sTBI). Methods: This is a non-prespecified secondary analysis of the Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial, which enrolled sTBI patients between 2014-2018, < 18 years, with Glasgow Coma Scale ≤8 and an ICP monitor, with hospital characteristics collected annually. United States (US) sites were included and assigned to nine regions per the US Census Bureau. Primary outcome of mortality, and secondary outcomes of functional neurological status (dichotomized Glasgow Outcome Score–Extended for Pediatrics), patient and hospital characteristics, and patient management were analyzed, and stratified by region. We developed a multivariable logistic regression (MLR) to evaluate regional risk factors associated with mortality. Results: Data from 31 US sites were analyzed (n=705 patients, 64% male, median 6 2-13 years). Mortality varied across regions (13-31%) but was not statistically significant. Unfavorable neurological outcomes were also similar across regions. Cause and mechanism of trauma varied regionally with motor vehicle accidents in East South Central (69%) and impact mechanism in South Atlantic (80%) being the most common (p< 0.001) but no difference in abusive head trauma (17%). Across regions, hospital characteristics including PICU patient volume and staffing practices were similar. Use of intraparenchymal and brain tissue oxygen monitors differed (p< 0.001), while extraventricular drain placement (33%) and surgical decompression (32%) were similar by region. Use of neuromuscular blockade, hyperventilation, and barbiturates varied across regions (p< 0.001). In MLR modeling, regionality was not associated with mortality after adjusting for patient and hospital characteristics. Conclusions: We found no differences in mortality or functional neurological outcomes in children after sTBI across US regions. Patient characteristics and management strategies varied by region, while hospital characteristics did not. Despite regional differences in patient presentation and management, outcomes remained consistent; potentially reflecting a patient-centered approach to care.