Highlights from #EAST2014 - Teen Trauma

In Ohio, there are no differences in outcome when adolescents are treated at Adult vs Pediatric Trauma Centers.   Since we have both Pediatric and Adult Trauma Centers under one roof, our adolescents should be covered either way.

TEEN TRAUMA WITHOUT THE DRAMA: OHIO ADOLESCENT TRAUMA OUTCOMES

Ashley E. Walther, MD, Timothy A. Pritts, MD, PhD*, Richard A. Falcone, Jr., MD, MPH*, Dennis Hanseman, PhD, Bryce R.H. Robinson, MD*
University of Cincinnati

Presenter: Ashley E. Walther, MD
Discussant: Barbara Gaines, MD, Children’s Hospital of Pittsburgh

Objectives: The optimal treatment facility for adolescent trauma patients is controversial. We sought to investigate risk-adjusted outcomes of adolescents treated at adult-only trauma centers (ATC) vs pediatric-only trauma centers (PTC) in a state system with legislated ACS-verified institutions in order to determine ideal pre- hospital referral patterns.

Methods: The Ohio Trauma Registry was queried for 15-19 year olds with a length of stay (LOS) >1 day at ATC (Level 1) or PTC (Level 1 and 2) from 2008-2012. Race, gender, ED vital signs, ISS, and CT imaging were reviewed. Outcomes by mechanism of injury included ventilator days, ICU LOS, hospital LOS, and mortality. Statistical analysis was performed using rank sum or Chi-square testing. Propensity score-based risk adjustment matching was used to compare groups (score within 0.01, ISS within 5).

Results: 5,793 adolescent patients were identified (84% blunt, 16% penetrating) with 66% treated at ATC. Unadjusted demographics and vital signs significantly differed between centers (p<0.01). For adolescents with blunt injury, more males (71.6% vs 66.3%, p<0.01) and non-whites (19.2% vs 15.8%, p<0.01) were seen at PTC. In 928 propensity-matched pairs for blunt trauma, no differences were seen in mortality or hospital LOS. ATC were found to have longer ICU LOS (0.3 days, p<0.01) and ventilator use (0.2 days, p=0.01). For penetrating trauma, more males (88.6% vs 50.8%, p<0.01) and non-whites (76.6% vs 68.6%, p<0.01) were admitted to ATC. In 115 propensity-matched pairs of penetrating injuries, no differences were seen in outcomes. In both injury patterns, CT imaging was more common at ATC (p<0.01).

Conclusions: Major outcome differences for injured adolescents do not exist between ATC and PTC, regardless of injury pattern. CT imaging remains more prevalent at ATC. In a state system with mandatory ACS-verified centers, injury patterns need not dictate triage decisions for adolescent patients.