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

Background/purposeThis study aims to investigate differences in imaging, procedure utilization, and clinical outcomes of severely injured adolescents treated at adult versus pediatric trauma centers.MethodsThe National Trauma Data Bank was queried retrospectively for adolescents, 15–19 years old, with a length of stay (LOS) > 1 day 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.ResultsOf 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.ConclusionsSeverely 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.