Pediatric Penetrating Trauma Volume and Patient Outcome: A National Trauma Data Bank Study

Firearm-related injuries have become the leading cause of death for US children. Although a "volume-outcome" relationship is well-established in adults, it is less understood in pediatric penetrating trauma. This study aimed to evaluate the relationship between trauma center volume and patient outcomes in pediatric penetrating injuries.

Utilizing the National Trauma Data Bank (2017-2021), we conducted a retrospective database study of pediatric patients (1-18 y) with stab or gunshot wounds (GSWs), treated at level I or II trauma centers. Patients with GSW to the head, interfacility transfers, or emergency department deaths were excluded. Trauma centers were categorized into quartiles based on penetrating injury volume. Primary outcomes were in-hospital mortality, intensive care unit length of stay, and ventilator dependency duration.

Of 666,111 patients, 34,064 with penetrating trauma were included, with 22,237 sustaining GSW. In-hospital mortality (4%-5%) did not significantly differ across volume quartiles. Patients at the highest-volume facilities (q4) experienced longer intensive care unit stays (4.33 d in q1 versus 5.45 d in q4, P < 0.001) and longer ventilator duration (3.22 d in q1 versus 4.90 d in q4, P < 0.001). After 3:1 matching to minimize confounding, prolonged ventilator dependency remained statistically significant in q4 facilities (relative risk = 1.256, P = 0.008), a trend also seen in the GSW subgroup (relative risk = 1.264, P = 0.016).

This study indicates that while trauma center volume may influence resource utilization for pediatric penetrating trauma, it does not significantly affect in-hospital mortality. Further research with more anatomically precise injury matching is warranted.