Lower Mortality Linked to Treatment of Injured Teens at Pediatric Trauma Centers

Treating injured adolescents at pediatric trauma centers was associated with a lower risk of death compared with treating them at adult trauma centers or at centers that treat both adult and pediatric patients, although the cause of those differences in mortality were unknown, according to an article published online by JAMA Pediatrics.
Few studies have looked at outcomes for adolescents treated at different types of trauma centers after injury.
Randall S. Burd, M.D., Ph.D., of the Children’s National Medical Center, Washington, and coauthors used national data to compare the mortality of injured adolescents treated at adult trauma centers (ATCs), pediatric trauma centers (PTCs) or mixed trauma centers (MTCs), which treat both pediatric and adult patients. Data from the 2010 National Trauma Data Bank were used to analyze mortality among patients ages 15 to 19 who sustained a blunt or penetrating injury (firearm, cut or pierce).
Most of the 29,613 injured adolescents were treated at ATCs (68.9 percent), with the rest treated at MTCs (25.6 percent) or PTCs (5.5 percent).
Teens treated at ATCs and MTCs had higher risk of death – 3.2 percent and 3.5 percent, respectively – than those treated at PTCs (0.4 percent), according to the study results.
The authors also report:
Teens treated at ATCs and MTCs were older and more severely injured.
Adolescents treated at PTCs were more likely to have blunt injury than penetrating injury (91.4 percent) compared with teens treated at ATCs (80.4 percent) or MTCs (84.6 percent).
Injury by assault was less frequent among adolescents treated at PTCs (11.5 percent) compared with those treated at ATCs (21.5 percent) and MTCs (16.2 percent).
Adolescents injured as motor vehicle occupants were most common at ATCs (32.6 percent) and MTCs (34.3 percent) compared with PTCs (18.5 percent).
Study limitations include an inability to provide information about what accounts for the mortality differences.
“Trauma centers dedicated to the treatment of pediatric patients see a different adolescent population than do ATCs and MTCs. After controlling for these differences, we observed that adolescent trauma patients have lower overall and in-hospital mortality when treated at PTCs. The optimal care of adolescents at all center types requires the identification of either additional patient differences or treatment practices that account for this mortality difference. Analysis of this association of specific care processes with mortality at center types will be needed to further clarify the etiology of these differences in mortality,” the study concludes.
(JAMA Pediatr. Published online June 27, 2016. doi:10.1001/jamapediatrics.2016.0805.