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Of 2117 admissions for severe pediatric traumatic brain injury, 67.3% were in high-level centers, and 87.3% were in either high-level or level II centers. We also explored how use of level II trauma centers affected rates of care at high-level centers. We considered an area to be well regionalized if ≥90% of severe traumatic brain injury hospitalizations were in high-level centers. We defined “high-level centers” as either level I or pediatric trauma centers. We identified children with severe traumatic brain injury by using International Classification of Diseases, Ninth Revision, Clinical Modification, codes and American College of Surgery Committee on Trauma criteria.

We studied population and hospital discharge data from 2001 from all of the health care referral regions ( n = 68) in 6 US states (Florida, Massachusetts, New Jersey, New York, Texas, and Virginia). We assessed rates of adherence to these recommendations and factors associated with adherence. On the basis of evidence of better outcomes, the American College of Surgery Committee on Trauma recommends that children with severe traumatic brain injury receive care at high-level trauma centers. Traumatic brain injury is a leading cause of death in children.

System shock mew system shock shodan mew e216