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J Pediatr Surg. 2016 Aug;51(8):1346-50. doi: 10.1016/j.jpedsurg.2016.03.016. Epub 2016 Apr 12.

Pediatric and adult trauma centers differ in evaluation, treatment, and outcomes for severely injured adolescents.

Author information

1
Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati College of Medicine, USA. Electronic address: waltheay@uc.edu.
2
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati College of Medicine, USA. Electronic address: richard.falcone@cchmc.org.
3
Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati College of Medicine, USA. Electronic address: prittsta@uc.edu.
4
Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati College of Medicine, USA. Electronic address: hansemdj@uc.edu.
5
Division of Trauma, Critical Care, and Burns, Department of Surgery, University of Washington, USA. Electronic address: brobinso@uw.edu.

Abstract

BACKGROUND/PURPOSE:

This study aims to investigate differences in imaging, procedure utilization, and clinical outcomes of severely injured adolescents treated at adult versus pediatric trauma centers.

METHODS:

The National Trauma Data Bank was queried retrospectively for adolescents, 15-19years old, with a length of stay (LOS) >1day and Injury Severity Score (ISS) >25 treated at adult (ATC) or pediatric (PTC) Level 1 trauma centers from 2007 to 2011. Patient demographics and utilization of imaging and procedures were analyzed. Univariate and multivariate regression analysis was used to compare outcomes.

RESULTS:

Of 12,861 adolescents, 51% were treated at ATC. Older age and more nonwhites were seen at ATC (p<0.01). Imaging and invasive procedures were more common at ATC (p<0.01). Shorter LOS (p=0.03) and higher home discharge rates (p<0.01) were seen at PTC. ISS and mortality did not differ. Age, race, ATC care (all p<0.01), and admission systolic blood pressure (SBP) (p=0.03) were predictors of CT utilization. ISS, SBP, and race (p<0.01) were risk factors for overall mortality; SBP (p=0.03) and ISS (p<0.01) predicted death from penetrating injury.

CONCLUSIONS:

Severely injured adolescents experience improved outcomes and decreased imaging and invasive procedures without additional mortality risk when treated at PTC. PTC is an appropriate destination for severely injured adolescents.

KEYWORDS:

Adolescents; Adult trauma center; Imaging; Pediatric trauma center; Trauma outcomes

PMID:
27132539
PMCID:
PMC5558261
DOI:
10.1016/j.jpedsurg.2016.03.016
[Indexed for MEDLINE]
Free PMC Article

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