Aims: To assess changes in trends of health care for TBI patients aged 0–15 locally from 2009 to 2014 in a local university hospital.

Methods: Retrospective review of local trauma database from 2009 to 2014 after IRB approval. Patients in the trauma database less than 16-year-old from 01/2009 to 12/2014 were included in the study. The sample size for the study was 601 pediatric patients. Frequency analysis of TBI was done. Distribution and percentages for types of TBI, insurance-coverage and mechanism of injury were also evaluated.

Results: Health maintenance organizations (HMOs) were the major insurance providers for patients with falls, sports related injury, assaults and suicide. In addition, car insurance was the majority insurance provider in motor vehicle accidents (MVA) and Pedestrian accidents. Medicaid coverage by itself was higher in assaults, suicide and falls but was a minor contributor in sports, MVA and pedestrian accidents. Furthermore, HMOs and Car Insurance were significantly high in age 4 to 10 and 11 to 15 and HMO and Medicaid higher in age 0 to 3. HMOs were the most predominant form of insurance coverage when insurance coverage was analyzed yearly. There was an overall decrease in the average length of stay from 2009 to 2014 (Negative correlation of r = -7073. However, the LOS for each diagnosis was not significantly different. Majority of patients had concussion with mostly being disposed to Home. In addition, very few patients with concussion with multiple co-morbidities like subdural and epidural were disposed to OR for surgery after CT diagnosis. Patients with SAH mostly were disposed to PICU. The distribution of ages varied by type of injury with age 9 to 15 highest for epidural hematoma, skull fractures, contusions, subarachnoid hemorrhage and concussion. Public buildings, recreational places and street related injuries were increasing for ages 4 to 10 and 10 to 15 years. For all age groups, Peds and ICU plus PICU were the most common places for admission and there were very few dispositions to floor, ICU and OR. Finally, of all the imaging (75 percent of total sample) that was performed 68 percent were positive and 32 percent were negative.

Conclusion: We note significant trends in the patterns of admission, diagnosis and injury. These changes could be related to the new insurance exchange program with better accessibility of health care along with an increase in Car Insurance coverage. The lower incidence of sports related injuries could be due to increased awareness and prevention efforts amongst parents and teenagers because of high school education programs. Changes in the trauma service protocol for management of pediatric head injury are likely responsible for our decrease in LOS. Further validation is required after analysis of procedures and outcomes through which we can determine whether it’s the efficiency of health care delivery or whether healthier patients are admitted which is leading to the decreased LOS.

Keywords: Brain, Diagnosis, Insurance, Length, Stay, Traumatic