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Comparison of Outcomes for Pediatric Trauma at Different Types of Trauma Centers: The Unresolved Mystery

Adel Elkbuli, Jennifer R Lopez, Paul Perales Villarroel

    The American Surgeon
    |July 9, 2018
    PubMed

    Insights

    Level 1 adult/pediatric trauma centers (TCs) in Florida show lower pediatric mortality rates compared to Level 2 TCs with associated pediatric hospitals. Outcomes were similar between Level 1 TCs and pediatric TCs at stand-alone pediatric hospitals.

    Area of Science:

    • Pediatric Trauma Care
    • Health Services Research
    • Outcomes Research

    Background:

    • Florida has three state-approved pediatric trauma center (TC) types: Level 1 combined adult/pediatric (L1, A + P), Level 2 with pediatric hospital (L2 + PH), and pediatric TC at pediatric hospital (PTH).
    • Comparing mortality outcomes across these TCs is crucial for optimizing pediatric trauma care delivery.

    Purpose of the Study:

    • To compare pediatric mortality outcomes among Florida's L1, A + P TCs, L2 + PHs, and PTHs.
    • To identify potential disparities in care and outcomes based on trauma center designation.

    Main Methods:

    • Retrospective review of Florida Agency for Health Care Administration data from 2013-2016.
    • Analysis of 13,428 pediatric trauma cases across all three TC types.
    • Outcomes stratified by observed over expected (O/E) mortality, with significance defined as P < 0.05.

    Main Results:

    • L1, A + P TCs (n=6975) had an O/E of 0.96.
    • L2 + PHs (n=4066) had an O/E of 1.21.
    • PTHs (n=2387) had an O/E of 1.25.
    • Significantly lower O/E at L1, A + P compared to L2 + PHs (P < 0.03).
    • No significant difference in O/E between L1, A + P and PTHs.

    Conclusions:

    • Level 1 adult/pediatric trauma centers demonstrate superior outcomes with lower pediatric mortality rates compared to Level 2 TCs with associated pediatric hospitals.
    • Outcomes at Level 1 adult/pediatric TCs are comparable to those at dedicated pediatric trauma centers.
    • Findings suggest a potential benefit of Level 1 combined adult/pediatric centers for pediatric trauma care.

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