Trauma and Aftercare: Adolescent Firearm Injuries at Pediatric Versus Adult Trauma Centers

Adolescent firearm injury (AFI) victims are treated at pediatric trauma centers (PTCs) and adult trauma centers (ATCs) based on triage criteria. We hypothesize that AFI patients at ATCs are more severely injured, while PTCs provide superior post-trauma aftercare.

A post hoc analysis of a cross-sectional study was conducted for patients aged 12-18 y at two urban level 1 trauma centers (PTC and ATC). Patient characteristics, outcomes, and social services were compared.

The PTC treated 105 patients (64%), while the ATC treated 58 (36%). ATC patients were older (17 versus 15 y, P = 0.029) and had higher Injury Severity Scores (9 versus 2, P < 0.001). The ATC cohort had higher rates of operating room use (43% versus 19%), intensive care unit admission (12% versus 3%), lower home discharge rates (64% versus 90%), and higher crude mortality (17% versus 3%, P = 0.002). On multivariable logistic regression adjusting for Injury Severity Score and systolic blood pressure, there was no difference in mortality between center types. PTC patients had more adverse childhood experiences (35% versus 10%, P < 0.001) and prior traumatic events (PTEs) (45% versus 3%, P < 0.001) identified, while mental illness was similar (16% versus 10%, P = 0.17). Psychosocial services were more frequent at the PTC (P < 0.001), including social work/case management (10% versus 2%) and Child Protective Services referrals (29% versus 0%).

AFI victims at the ATC experience more severe injuries, but the PTC provides better recognition of adverse childhood experiences, PTEs, and psychosocial services. A prospective study is needed to develop a pathway that integrates optimal resuscitation with comprehensive post-trauma support.