Citation

Rogers AT, Gross BW, Cook AD, Rinehart CD, Lynch CA, Bradburn EH, Heinle CC, Rogers FB. J. Trauma Acute Care Surg. 2017; 83(6): 1082-1087.

Affiliation

1 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA 2 Trauma Services, Lancaster General Health/Penn Medicine, Lancaster, PA, USA 3 Trauma Research Program, Chandler Regional Medical Center, Chandler, AZ, USA.

Copyright

(Copyright © 2017, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001642

PMID

28697019

Abstract

BACKGROUND: Previous research suggests adolescent trauma patients can be managed equally effectively at pediatric and adult trauma centers. We sought to determine whether this association would be upheld for adolescent severe polytrauma patients. We hypothesized that no difference in adjusted outcomes would be observed between pediatric trauma centers (PTC) and adult trauma centers (ATC) for this population.

METHODS: All severely injured adolescent (aged 12-17 years) polytrauma patients were extracted from the Pennsylvania Trauma Outcomes Study database from 2003-2015. Polytrauma was defined as an Abbreviated Injury Scale (AIS) score ≥3 for two or more AIS-defined body regions. Dead on arrival, transfer, and penetrating trauma patients were excluded from analysis. ATC were defined as adult-only centers, while standalone pediatric hospitals and adult centers with pediatric affiliation were considered PTC. Multilevel mixed-effects logistic regression models assessed the adjusted impact of center type on mortality and total complications while controlling for age, shock index, Injury Severity Score, Glasgow Coma Scale motor score, trauma center level, case volume, and injury year. A generalized linear mixed model characterized functional status at discharge (FSD) while controlling for the same variables.

RESULTS: A total of 1,606 patients met inclusion criteria (PTC: 868 [54.1%]; ATC: 738 [45.9%]), 139 (8.66%) of which died in-hospital. No significant difference in mortality (AOR: 1.10, 95%CI 0.54-2.24; p=0.794; AUROC: 0.89) was observed between designations in adjusted analysis, however, FSD (AOR: 0.38 95%CI 0.15-0.97; p=0.043) was found to be lower and total complication trends higher (AOR: 1.78 95%CI 0.98-3.32; p=0.058) at PTC for adolescent polytrauma patients.

CONCLUSION: Contrary to existing literature on adolescent trauma patients, our results suggest patients aged 12-17 presenting with polytrauma may experience improved overall outcomes when managed at adult compared to pediatric trauma centers. LEVEL OF EVIDENCE: Level III, Epidemiologic study.

Language: en