{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:06:46Z","timestamp":1789387606018,"version":"build-2803163510"},"reference-count":47,"publisher":"SAGE Publications","issue":"19-20","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:p>\n                    Optimal transfer strategies for pediatric traumatic brain injury remain debated: direct transfer to a specialist neuroscience center expedites access to neurosurgical care, whereas indirect transfer via a trauma unit allows initial stabilization before secondary transfer. We retrospectively analyzed 375 pediatric traumatic brain injury admissions managed under United Kingdom national guidelines (2019\u20132024): 184 (49%) were transferred directly to a specialist neuroscience center and 191 (51%) were initially transported to a trauma unit before secondary transfer. Outcomes were assessed using the Pediatric Glasgow Outcome Scale-Extended. The primary outcome was good recovery (upper or lower good); secondary outcomes were time to neurosurgical care, length of stay, complications, and mortality. Propensity score matching and generalized linear models were used to adjust for confounding, with a sensitivity analysis including patients with more than 30 days of follow-up. Protocol fidelity for triage to direct or indirect transfer was 95.2%. Before matching, patients in the direct transfer group were older and had more severe clinical features. In the matched cohort (156 direct, 176 indirect), 81.6% were managed conservatively. Although not statistically significant, follow-up duration was longer in the direct transfer group. Good recovery occurred in 79% of the direct group and 80% of the indirect group, with no significant association between transfer pathway and good recovery (adjusted odds ratio 1.02, 95% confidence interval 0.57\u20131.86). Times from injury to CT scan, neurosurgical referral, and neurosurgical intervention were significantly shorter in the direct transfer group (all\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.05). No between-group differences were observed in length of stay, inpatient or long-term complications, or mortality. The sensitivity analysis yielded concordant findings. Direct transfer shortened the time to neurosurgical care, but within the detectable effect size of this study, no pathway-related difference in clinical outcomes was demonstrated.\n                  <\/jats:p>","DOI":"10.1177\/08977151261433752","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T06:23:57Z","timestamp":1773901437000},"page":"1598-1611","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing Direct and Indirect Transfer Pathways for Pediatric Traumatic Brain Injury: Insights from a UK Specialist Neuroscience Center"],"prefix":"10.1177","volume":"43","author":[{"given":"Peter","family":"Adidharma","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK."},{"name":"Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Callum M.","family":"Allison","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK."},{"name":"Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venetia","family":"Giannakaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nithish","family":"Jayakumar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian C.","family":"Coulter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0439-2278","authenticated-orcid":false,"given":"Christopher J.A.","family":"Cowie","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK."},{"name":"Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016355"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/02688697.2020.1858026"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-024-01229-7"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181e243b8"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2004.12.016"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2024.39.e60"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000121145"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2013.804137"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2016.03.045"},{"key":"e_1_3_2_11_1","unstructured":"10.The North East population. 2024. 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