{
  "abstract": "Objective Traumatic brain injury (TBI) is common in childhood, with mild TBI (mTBI) predominating. Germany reports higher hospitalisation rates for paediatric TBI than any other country, suggesting overadmission of mild cases. The study objective was to determine TBI-related hospitalisations in patients <18 years from 2014 to 2020 and describe variability of TBI-related hospitalisations between emergency departments (EDs).Design Retrospective observational study using the German hospital dataset (GHD) and controlling data from 18 paediatric EDs.Setting Cases were identified from the GHD using International Classification of Diseases-10 codes and classified by severity using the Abbreviated Injury Scale for the head. Additionally, the proportion of inpatient versus outpatient TBI management from 18 paediatric EDs was assessed.Patients Cases with TBI as discharge diagnosis hospitalised in Germany (GHD) or presenting at a participating ED.Interventions N/A.Main outcome measures Standardised morbidity ratios (SMRs) for 2020 with 2014–2019 as reference period (GHD); proportion of hospitalisations of TBI patients per ED.Results Among 618 577 TBI cases, mean annual TBI hospitalisations declined from 91 299±1656 (mean±SD) cases in 2014–2019 to 70 783 in 2020. SMRs for all-cause admissions (0.83 (95% CI 0.81 to 0.85)) and mTBI (0.75 (95% CI 0.73 to 0.78)) decreased more strongly than for moderate and severe TBI (0.95 (95% CI 0.91 to 0.99) and 0.95 (95% CI 0.90 to 1.01)). Hospitalisation rates in EDs ranged from 19.1% to 93.0% (median: 75.0%).Conclusions and relevance The disproportionate reduction of mTBI hospitalisations during the COVID-19 pandemic compared with moderate to severe cases suggests that there is potential for safely managing more mild cases in outpatient settings.",
  "authors": [
    {
      "affiliations": [
        "Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, Essen, Germany"
      ],
      "name": "Nora Bruns"
    },
    {
      "affiliations": [
        "Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, Essen, Germany"
      ],
      "name": "Rayan Hojeij"
    },
    {
      "affiliations": [
        "Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, Essen, Germany"
      ],
      "name": "Pia Brensing"
    },
    {
      "affiliations": [
        "Department of Pediatrics, University of Würzburg, Würzburg, Germany"
      ],
      "name": "Oliver Andres"
    },
    {
      "affiliations": [
        "Clinic for Child and Adolescent Medicine, Klinikum Esslingen, Esslingen, Germany"
      ],
      "name": "Christian von Schnakenburg"
    },
    {
      "affiliations": [
        "Clinic for Pediatric Surgery and Orthopedics, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany"
      ],
      "name": "Catharina Anna Neumann"
    },
    {
      "affiliations": [
        "Department of Pediatric Surgery, University Hospital Dresden - Technical University of Dresden, Dresden, Germany"
      ],
      "name": "Eric Waltersbacher"
    },
    {
      "affiliations": [
        "Clinic for Pediatrics, Adolescent medicine, and Neonatology, Klinikum Kempten, Klinikverbund Allgäu, Technical University Munich, Kempten (Allgäu), Germany"
      ],
      "name": "Hendrik Juenger"
    },
    {
      "affiliations": [
        "Department of Pediatric Respiratory Medicine, Immunology, and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany"
      ],
      "name": "Martin Grieser"
    },
    {
      "affiliations": [
        "Children’s Center Bethel, University of Bielefeld, Bielefeld, Germany"
      ],
      "name": "Sebastian Gaus"
    },
    {
      "affiliations": [
        "University Children's Hospital, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany"
      ],
      "name": "Thomas Lücke"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany"
      ],
      "name": "Friedrich Reichert"
    },
    {
      "affiliations": [
        "Department of Pediatrics, University Medical Center Eppendorf, Hamburg, Germany"
      ],
      "name": "Jan Beime"
    },
    {
      "affiliations": [
        "Department of Pediatric Surgery, University Medicine Greifswald, Greifswald, Germany"
      ],
      "name": "Vera Schellerer"
    },
    {
      "affiliations": [
        "Department of Pediatric Surgery, Medical Center Dortmund, Dortmund, Germany"
      ],
      "name": "Andreas Leutner"
    },
    {
      "affiliations": [
        "Institute for Social Pediatrics and Adolescent Medicine, Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany"
      ],
      "name": "Anna-Lisa Oechsle"
    },
    {
      "affiliations": [
        "Department of Pediatric Surgery and Pediatric Urology, Diakoneo Cnopfsche Kinderklinik, Nuremberg, Germany"
      ],
      "name": "Johannes Meyer"
    },
    {
      "affiliations": [
        "Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany"
      ],
      "name": "Alexandra Fröba-Pohl"
    },
    {
      "affiliations": [
        "Department of Paediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, LMU Munich, Munich, Germany"
      ],
      "name": "Johanna Wagner"
    },
    {
      "affiliations": [
        "Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital of Düsseldorf, Düsseldorf, Germany"
      ],
      "name": "Viviane Klingmann"
    },
    {
      "affiliations": [
        "Children’s Hospital, St. Marien gGmbH, Landshut, Germany"
      ],
      "name": "Karl F Schettler"
    },
    {
      "affiliations": [
        "Children’s Hospital Passau, Technical University Munich, Passau, Germany"
      ],
      "name": "Matthias Keller"
    },
    {
      "affiliations": [
        "Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, Essen, Germany"
      ],
      "name": "Ursula Felderhoff-Mueser"
    },
    {
      "affiliations": [
        "Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, Essen, Germany"
      ],
      "name": "Christian Dohna-Schwake"
    },
    {
      "affiliations": [
        "Department of Paediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, LMU Munich, Munich, Germany"
      ],
      "name": "Florian Heinen"
    },
    {
      "affiliations": [
        "Department of Paediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, LMU Munich, Munich, Germany"
      ],
      "name": "Michaela Bonfert"
    }
  ],
  "title": "Reduced hospitalisations for paediatric mild traumatic brain injury: a nationwide observational study",
  "uid": "6476d1eb-fb2b-5e50-b9b9-413b402cfd1a"
}