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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.
Insights
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.
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.
Introduction:
Prior studies have demonstrated improved outcomes for admitted children at pediatric-only hospitals (POHs) (e.g. children's hospitals) versus combined pediatric-adult trauma centers (CPACs). However, there is a paucity of data regarding disparities of overall and intensive care unit (ICU) admissions between POHs and CPACs. This study compared POHs versus CPACs, hypothesizing increased overall and ICU admissions at CPACs.
Methods:
A retrospective (2017-2021) analysis of the Trauma Quality Improvement Program database was performed, comparing 1-14-y-old patients treated at POHs versus CPACs. The primary outcomes were overall and ICU admissions rates. Secondary outcomes include inpatient complications and mortality. Two separate multivariable logistic regression analyses evaluated associated risk of mortality and risk of complications for those admitted, controlling for age, injury severity score, mechanism of injury, and brain injury.
Results:
Of 199,414 children, 110,041 (55.2%) were treated at POHs and 89,373 (44.8%) at CPACs. Patients admitted to POHs were slightly younger (median 7 versus 8 y-old, P < 0.001) and had a decreased yet statistically different median injury severity score (POH: 4 versus CPAC: 5, P < 0.001). CPAC patients had increased overall (77.8% versus 66.2% P < 0.001) and ICU admissions (13.6% versus 6.3%, P < 0.001). POH patients had statistically decreased complications (1.2% versus 1.3%, P = 0.041) and mortality (0.7% versus 0.9%, P < 0.001). However, these findings did not persist on multivariable analysis (complications: P = 0.99; mortality: P = 0.12).
Conclusions:
This national analysis demonstrated differences in admission patterns between POHs and CPACs. The higher admission rates at CPACs yet similar associated risk of complications and mortality suggest a potential opportunity for improvement efforts at these centers.
