Comparison of pediatric motor vehicle collision injury outcomes at Level I trauma centers ★

ObjectiveExamine the association of American College of Surgeons Level I pediatric trauma center designation with outcomes of pediatric motor vehicle collision-related injuries.MethodsObservational study of the 2009–2012 National Trauma Data Bank, including n = 28,145 patients < 18 years directly transported to a Level I trauma center. Generalized estimating equations estimated odds ratios (ORs) for injury outcomes, comparing freestanding pediatric trauma centers (PTCs) with adult centers having added Level I pediatric qualifications (ATC + PTC) and general adult trauma centers (ATC). Models were stratified by age following PTC designation guidelines, and adjusted for demographic and clinical risk factors.ResultsAnalyses included n = 16,643 children < 15 and n = 11,502 adolescents 15–17 years. Among children, odds of laparotomy (OR = 1.88, 95% CI 1.28–2.74) and pneumonia (OR = 2.13, 95% CI 1.32–3.46) were greater at ATCs vs. freestanding PTCs. Adolescents treated at ATC + PTCs or ATCs experienced greater odds of death (OR = 2.18, 95% CI 1.30–3.67; OR = 1.98, 95% CI 1.37–2.85, respectively) and laparotomy (OR = 4.33, 95% CI 1.56–12.02; OR = 5.11, 95% CI 1.92–13.61, respectively).ConclusionsCompared with freestanding PTCs, children treated at general ATCs experienced more complications; adolescents treated at ATC + PTCs or general ATCs had greater odds of death. Identification and sharing of best practices among Level I trauma centers may reduce variation in care and improve outcomes for children.