(305) Age and Sex Disparities in Medical Therapies and Outcomes in Children After Severe TBI

Introduction: Literature suggests that poor outcomes after pediatric severe TBI (sTBI) are more common in males and younger age groups. We aimed to investigate the age- and sex-related differences in medical therapies and outcomes in children after sTBI.

Methods: We performed a secondary analysis of the Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial which included patients ≤18y with sTBI (Glasgow Coma Scale ≤ 8). Sex was defined as male or female. Age groups were stratified according to published guidelines. We examined medical therapies, mortality, and morbidity, with an unfavorable outcome defined as a Glasgow Outcome Score Extended Pediatric (GOS-EP) of 5-8.

Results: One thousand sTBI patients (6y [interquartile range 6-12y], 65% male, 26% Infant/Toddler (I/T) (≤ 2y), 21% Early Childhood (CH) (2-5y), 26% Middle CH (5-11y) and 28% Early Adolescence (EA) (11-18y) were analyzed from 49 centers. Males were significantly older with higher penetrating TBI and lower Abbreviated Injury Score (AIS) (p < 0.05). Significant age-based trends included: I/T with the highest incidence of acceleration/deceleration mechanism, abusive head trauma, surgical evacuation, and lowest AIS; EA was majority White race, had the highest motor vehicle accident and impact mechanism, highest AIS, and lowest PRISM III scores (all p < 0.05). There were no statistically significant differences in medical therapies between sex. The use of barbiturates and surgical intervention was statistically higher in I/T and Early CH groups (p < 0.05). No statistical differences in mortality or morbidity were observed with respect to age or sex.

Conclusions: From the largest pediatric sTBI cohort to date, no statistically significant differences were identified between morbidity and mortality when stratified by age or sex. These findings are in contrast to previous literature. However, our analysis showed variations in the presenting injury characteristics and significantly higher utilization of barbiturates and surgical interventions in younger children. These findings highlight the heterogeneity of pediatric sTBI, and potential to tailor therapies based on injury and patient-level factors that will ultimately lead to improved outcomes.