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Association Between Trauma Center Type and Mortality Among Injured Adolescent Patients.

Rachel B Webman1, Elizabeth A Carter1, Sushil Mittal2

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Injured adolescents had lower mortality rates when treated at pediatric trauma centers (PTCs) compared to adult trauma centers (ATCs) or mixed trauma centers (MTCs). Further research is needed to understand factors influencing these outcomes for better adolescent trauma care.

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Area of Science:

  • Trauma Surgery
  • Public Health
  • Adolescent Medicine

Background:

  • Trauma is a leading cause of death and disability in adolescents.
  • Existing data suggest improved outcomes for children at pediatric trauma centers (PTCs) but less clarity for adolescents treated at adult trauma centers (ATCs).

Purpose of the Study:

  • To compare mortality rates of injured adolescents across different trauma center types: ATCs, PTCs, and mixed trauma centers (MTCs).
  • To determine discharge disposition for survivors based on the type of trauma center.

Main Methods:

  • Utilized data from the 2010 National Trauma Data Bank, including level I and II trauma centers.
  • Employed multilevel models to analyze mortality for 29,613 adolescents (ages 15-19) treated for blunt or penetrating injuries.
  • Controlled for patient demographics, injury severity (Abbreviated Injury Scale), and initial physiological status (systolic blood pressure, Glasgow Coma Scale).

Main Results:

  • Adolescents treated at PTCs (5.5%) had significantly lower mortality (0.4%) compared to those at ATCs (68.9%; 3.2% mortality) and MTCs (25.6%; 3.5% mortality).
  • Adjusted analysis showed higher odds of mortality at ATCs (OR, 4.19) and MTCs (OR, 6.68) versus PTCs.
  • No significant difference in mortality was observed between Level I and Level II trauma centers.

Conclusions:

  • Mortality for injured adolescents is lower in PTCs compared to ATCs and MTCs.
  • Identifying specific center characteristics and resources that contribute to better outcomes is crucial for optimizing adolescent trauma care.