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Adolescent mortality lower when treated at pediatric trauma centers
Recent research in JAMA Pediatrics found that adolescent trauma-related mortality was reduced when patients were treated at pediatric trauma centers compared with those treated at adult and mixed trauma centers.
“As adolescents transition into adulthood, their medical care changes from delivery by pediatric to adult health care professionals,” Rachel B. Webman, MD, of the division of trauma and burn surgery at the Children’s National Medical Center in Washington, D.C., and colleagues wrote. “This transition also occurs for adolescents’ hospital-based treatment after injury, with more adolescent trauma patients being treated at centers that primarily treat injured adults."
“The objectives of this article are to determine whether type of trauma center designation is associated with mortality among adolescent trauma patients … and to determine differences among patients presenting to different center types.”
Webman and colleagues developed multilevel statistical models using data related to blunt or penetrating injury hospitalizations for adolescents aged 15 to 19 years, from the 2010 National Trauma Data Bank. Models were created for pediatric, adult and mixed trauma centers to compare the center-specific characteristics. The investigators studied 1,639 patient records from pediatric centers, 20,402 from adult centers and 7,572 from mixed care centers.
Study data indicated that the mortality rate for adolescents was greater at adult (3.2%) and mixed care centers (3.5%) when compared with treatment at pediatric trauma care centers (0.4%; P < .001). Furthermore, researchers found that the adjusted odds of mortality were higher at adult (OR = 4.19; 95% CI, 1.3-13.51) and mixed care centers (OR = 6.68; 95% CI, 2.03-21.99) vs. pediatric trauma centers. The OR, however, did not differ between level I and level II trauma centers (OR = 0.76; 95% CI, 0.59-0.99).
“The optimal care of adolescents at all center types requires the identification of either additional patient differences or treatment practices that account for this mortality difference,” Webman and colleagues wrote. “Analysis of the association of specific care processes with mortality at center types will be needed to further clarify the etiology of these differences in mortality.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
