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Comparing Admission Patterns Between Combined Pediatric-Adult and Pediatric-Only Trauma Centers.

Shaina Sedighim¹, Areg Grigorian¹, Catherine M Kuza²

¹Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California.

The Journal of Surgical Research

|June 8, 2025

Summary

Combined pediatric-adult trauma centers (CPACs) admit more children overall and to the intensive care unit (ICU) than pediatric-only hospitals (POHs). However, adjusted analyses show similar risks for complications and mortality, indicating areas for improvement at CPACs.

Keywords:

Admission disparities Combined pediatric/adult trauma centers Pediatric hospitals Pediatric trauma care

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Area of Science:

Pediatric Trauma Care
Hospital Systems Analysis
Public Health

Background:

Previous research indicates better outcomes for children treated at pediatric-only hospitals (POHs) compared to combined pediatric-adult trauma centers (CPACs).
Limited data exists on disparities in overall and intensive care unit (ICU) admissions between POHs and CPACs.
This study addresses this gap by comparing admission patterns and outcomes at POHs and CPACs.

Purpose of the Study:

To compare overall and ICU admission rates for pediatric trauma patients at POHs versus CPACs.
To investigate disparities in inpatient complications and mortality between POHs and CPACs.
To hypothesize increased admissions at CPACs.

Main Methods:

Retrospective analysis of the Trauma Quality Improvement Program database (2017-2021).
Comparison of 1-14-year-old patients treated at POHs versus CPACs.
Multivariable logistic regression analyses to evaluate risks of mortality and complications, controlling for key patient and injury factors.

Main Results:

CPAC patients exhibited higher overall (77.8% vs. 66.2%) and ICU (13.6% vs. 6.3%) admission rates.
Pediatric-only hospital patients had slightly lower median injury severity scores (4 vs. 5).
After multivariable adjustment, no significant differences in the risk of complications (P=0.99) or mortality (P=0.12) were observed between POHs and CPACs.

Conclusions:

Significant differences exist in pediatric trauma patient admission patterns between POHs and CPACs.
CPACs demonstrate higher admission rates, but adjusted outcomes for complications and mortality are comparable.
There is a potential opportunity to optimize care and admission practices at combined centers.