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Pediatric Trauma Centers Are Associated With a Lower Frequency of Operative Intervention for Isolated Mandible
Lang Liang1, Tim T Wang2, Nicholas Wilken3
1DMD Candidate, Harvard School of Dental Medicine, Boston, MA.
Background:
Management of pediatric mandibular fractures varies across institutions and remains a subject of ongoing clinical debate. However, it remains unclear if treatment at a pediatric designated trauma center influences management.
Purpose:
The purpose was to measure the association between pediatric trauma center designation and operative intervention for isolated mandibular fractures.
Study Design, Setting, Sample:
This retrospective cohort study used the American College of Surgeons National Trauma Data Bank, 2018 to 2023. Patients ≤16 years old with an isolated mandible fracture were included. Patients with multiple traumatic injuries and/or missing data were excluded.
Predictor Variable:
The primary predictor was designation as a pediatric trauma center (yes/no).
Main Outcome Variable:
The primary outcome was operative intervention (yes/no). Operative intervention included open reduction internal fixation or closed reduction.
Covariates:
Covariates were categorized as demographic (age, sex), injury-related (injury severity score), and hospital-level variables (teaching status, bed size).
Analyses:
Descriptive, bivariate, and multivariable regression statistics were computed to measure the association between pediatric trauma center designation and operative intervention. An alpha threshold of P < .05 was considered statistically significant.
Results:
The cohort included 3,689 subjects with a mean age of 11.2 ± 4.6 years (70.4% male, n = 2,596). Within this cohort, 1,919 (52.0%) presented to a pediatric trauma center. A total of 2,123 subjects (57.5%) underwent operative intervention. In the bivariate analysis, treatment at a pediatric trauma center was associated with a lower frequency of operative intervention (relative risk 0.89; 95% CI 0.84 to 0.94, P < .001). After adjusting for study covariates, treatment at a pediatric trauma center remained associated with lower odds of operative intervention (odds ratio 0.86; 95% CI, 0.74 to 0.99, P = .04). Inbound interfacility transfer was also associated with nonoperative management (odds ratio 0.52; 95% CI, 0.45 to 0.60, P < .001). Treatment modality was generally consistent across centers, though pediatric centers utilized open reduction internal fixation more frequently in the youngest cohort (0 to 5 years, 72.7 vs 55.6%, P = .02).
Conclusion And Relevance:
Patients presenting to pediatric trauma centers have lower odds of operative intervention for isolated mandibular fractures. In addition, transferred patients were less likely to undergo surgery, supporting further investigation of alternative triage and consultation pathways.
