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Daniel A. Donoho, Timothy Wen, Jonathan Liu, Hosniya Zarabi, Eisha Christian, Steven Cen, Gabriel Zada, J. Gordon McComb, Mark D. Krieger, William J. Mack, and Frank J. Attenello

expertise through increased procedural volume, and the training and retention of specialists. 6 , 20 , 24 , 37 The National Association of Children’s Hospitals and Related Institutions (NACHRI) recognizes over 220 specialized pediatric hospitals. To date, no large-scale national studies have examined the effects of pediatric hospital designation on the outcomes of neurosurgical procedures for malignant pediatric brain tumors. For the purpose of assessing this relationship, a national database may be uniquely useful. The largest source of nationwide patient-level pediatric

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Shenae Samuels, Rebekah Kimball, Vivian Hagerty, Tamar Levene, Howard B. Levene, and Heather Spader

ages. 1 Treatment and outcomes for TBI vary widely based on many factors. Some factors are patient dependent, including mechanism, severity of injury, and presence of polytrauma. 2 , 3 Others, such as physician decision-making and hospital resources, are dependent on where the patient is treated. 4 , 5 For example, previous research has demonstrated a positive relationship between hospital volume and outcome in TBI. 6 Hospitals can be distinguished based on qualitative differences such as ownership type and children's hospital designation status. Hospitals can be