The impact of treatment in a non-pediatric department on mortality and outcomes of children with traumatic brain injury (TBI) is unknown. This study aimed to quantify the impact of the treating department (pediatric (PD) or adult (AD)) on in-hospital case fatality and functional short-term outcomes in children with serious TBI who survived the initial 12 hours after hospital admission. A Nationwide retrospective cohort study was conducted from a dataset that comprises all discharges from German hospitals from 2016 to 2021. Disease and procedural codes were used to retrieve clinical and outcome information. Hierarchical multilevel logistic regression modeling was performed to quantify the effect of the treating department on the outcomes of interest. Eligibility criteria were age < 18 years and hospital admission with serious TBI. The main outcome was in-hospital death and secondary outcomes were pediatric complex chronic conditions category (PCCC) >= 2 in survivors, composite outcome (death or PCCC >= 2), and adjusted mean PCCC in survivors. Of 13,492,528 pediatric cases, 12,275 were included. The adjusted odds ratio (OR) for death was 3.00 (95 % confidence interval 1.93-4.68) for children treated in ADs compared to PDs. The OR for PCCC >= 2 was 0.93 (0.78-1.12) and 1.04 (0.87-1.25) for the composite outcome. Adjusted average PCCC were 0.40 (0.37-0.44) in ADs and 0.44 (0.42-0.46) in PDs. This comprehensive nationwide study found increased odds for in-hospital death but similar functional outcomes at discharge among surviving children with serious TBI who were treated outside of PDs.

The authors have declared no competing interest.

This study was funded by the save-my-brain foundation.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Secondary data were used that do not require ethics approval according to local legislation. All data were checked by the German data protection officer before being approved for publication. The German hospital dataset (GHD) is a nationwide dataset comprising all hospitalizations in public hospitals in the country. As per §21 KHEntgG, it is mandated by law that German hospitals share data on all hospital admissions with the Hospital Remuneration System (InEK). After passing plausibility checks, this data is anonymized and forwarded to the Federal Statistical Office. Detailed information on the structure of the DRG dataset is available at the Federal Statistical Office and further details on the process of data access at https://www.forschungsdatenzentrum.de/en/health/drg.

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The data from this study are available at the Federal research data center after written inquiry to the corresponding authorities.