Hello, everyone. My name is Piyas Patel. I'm a fourth year medical student at Vanderbilt. Thank you all for the opportunity to present our study on rural urban disparities and the effects of institutional care volume for pediatric traumatic brain injury. I have no disclosures to report. So the treatment of pediatric traumatic brain injury can often put two key factors in conflict. Number one, we know that treatment at high-volume trauma centers leads to generally better outcomes. And we also know that delayed time to arrival can lead to worse outcomes. And this can be a problem, especially for rural-dwelling children who typically live further from trauma centers. So our big question here was, are rural-dwelling patients being triaged effectively to high-volume trauma centers? The more specific aim was to determine whether institutional volume of annual pediatric TBI cases affects outcomes differently for rural-dwelling children after adjusting for injury severity and mechanism features. So we derived our data from the 2012 to 2015 National Inpatient Sample. We selected patients who had a TBI diagnosis aged 0 to 19 years without birth-associated trauma. And we divided these patients into rural-dwelling and urban-dwelling cohorts. We measured medical complication, mortality, length of stay, and cost as our primary outcomes. And primary variable was the annual volume of pediatric TBI cases at the hospital that is treating a given patient. You can see our covariates and our statistical methods below. Our analysis of baseline characteristics showed that the rural-dwelling children cohort had a significantly higher across-the-board measurement of injury severity, as measured by APR-DRG mortality score, intracranial monitor placement, and other traumatic injury present at the time of assessment, as well as a higher propensity for being admitted for vehicular mechanism of injury, which is generally associated with a higher grade of severity. So looking at our clinical outcomes, we find first that rural-dwelling patients have a higher rate of medical complication while in hospital, as well as in-hospital mortality, in comparison to urban-dwelling patients. After an adjusted analysis of both populations to find predictive features of these outcomes, we found that neither of these outcomes is associated with institutional TBI volume. You can see here the illustration of increasing institutional volume with the odds of outcome. And we see they're insignificant for all combinations of cohort and outcome. In terms of hospital operational outcomes, we again see that the rural-dwelling population had a higher distribution for both length of stay and cost. In adjusted model analysis of these outcomes, we see that for length of stay, the urban-dwelling population had a significant non-linear relationship between institutional TBI volume and length of stay, which peaks at approximately 25 cases per year. For cost, we see for both populations a non-linear significant relationship between institutional TBI volume and the outcome. And for the rural-dwelling population, it plateaus at about 50 cases per year. In conclusion, we found that institutional TBI volume does not impact clinical outcomes, but does impact length of stay and cost after adjustment, which suggests that current routing and triage systems may be effective and also shows opportunities for hospital-level improvements. We also found that rural-dwelling pediatric TBI patients generally have worsened injury severity, mortality, and in-hospital complications compared to urban-dwelling patients, which shows a need for further research on alternative disparities. I'd like to thank my mentors and thank you all for your time.

rural-urban disparities

institutional care volume

pediatric traumatic brain injury

outcomes

disparities