A Comparison of Pediatric Trauma Patients Presenting to a Pediatric vs Adult Trauma Center: When Do Kids Become Adults?
DOI:
https://doi.org/10.70422/m2pevf54Keywords:
Pediatric Surgery, Trauma Surgery, critical care, pediatric trauma, adult traumaAbstract
Introduction: There are few pediatric trauma centers (PTC), resulting in frequent treatment of pediatric patients at adult trauma centers (ATC). Locally, a level 2 PTC and level 1 ATC without pediatric specific trauma designation share the care of pediatric trauma patients. We compared characteristics and outcomes of pediatric patients (< 19 years) presenting at a PTC vs ATC.
Methods: The trauma databases of the University of Nebraska Medical Center and Children's Nebraska, respectively an ATC and PTC, were examined from January 2015 to June 2022. Demographics, patient characteristics, and outcomes were analyzed using appropriate non-parametric tests.
Results: 4818 PTC and 2259 ATC patients were evaluated. Blunt mechanisms predominated, but the PTC saw fewer penetrating injuries (4.4% vs 10.1%). Male gender predominated, while PTC patients were younger. The PTC saw a lower percentage of moderate, serious, and severe injuries and admitted a lower percentage of patients with shorter length of stay (LOS). The PTC had fewer admissions to the ICU, but had similar ICU LOS. Fewer patients at the PTC were ventilated but had more ventilator days per patient. Overall mortality was lower at the PTC. Examining only severely injured patients, there was no difference in mortality. Patients with minor injuries had shorter LOS at the PTC.
Conclusions: The PTC saw more patients and those with minor injuries were discharged faster. The ATC saw older patients with higher Injury Severity Score (ISS). However, mortality was similar between the two centers. Older, more severely injured pediatric trauma patients may benefit from care at an ATC, while less severely injured patients may receive more efficient care at a PTC.
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