Differences Between Pediatric & Adult Trauma Centers
There is substantial data showing pediatric trauma centers are better for young children, but evidence for adolescents aged 15-19 is less clear.
A prior Ohio-only study showed no difference in outcomes for 15-19 year olds whether treated at adult or pediatric trauma centers.
The National Trauma Data Bank study included patients aged 15-19 with injury severity scores greater than 25 over a 5-year period, totaling almost 13,000 patients.
51% of severely injured adolescents in the study were treated at adult trauma centers and 49% at pediatric trauma centers.
The median injury severity score (ISS) in the study population was 33.
45% of patients in the study had Glasgow Coma Scale scores less than 8, indicating severe brain injuries.
There was no significant difference in mortality between severely injured adolescents treated at adult versus pediatric trauma centers.
Adolescents treated at adult trauma centers were approximately 81% more likely to have an imaging study performed compared to those at pediatric trauma centers.
Severely injured adolescents had shorter length of stay at pediatric trauma centers compared to adult trauma centers.
Severely injured adolescents had shorter ICU length of stay at pediatric trauma centers compared to adult trauma centers.
More adolescents were discharged to home (as opposed to rehab or skilled nursing facilities) when treated at pediatric trauma centers compared to adult trauma centers.
Mortality is not the most important or reliable outcome for pediatric trauma because most children survive once they reach a hospital.
Expert opinionRich Falcone0:14
Pediatric trauma centers add value for children even up into the adolescent age range (15-19 years).
Expert opinionRich Falcone0:14
Adult trauma centers need to achieve equivalent imaging and length of stay practices to pediatric trauma centers for adolescents, since 51% of this population presents to adult facilities.
Expert opinionRich Falcone0:14
Pediatric trauma centers can achieve equivalent outcomes with less imaging by trusting clinical diagnosis and examination, avoiding unnecessary radiation exposure.
A recent study showed that referring hospitals had higher imaging rates than children's hospitals for appendicitis.
Pediatric Gun Violence: Pediatric Trauma Series 2017
Over the last 25 years, mortality from pediatric trauma has decreased by about 50%.
Trauma is still the single most common cause of death in the pediatric population and more common than all other causes combined.
Among pediatric injury deaths at trauma centers, motor vehicle crashes are the number one cause, followed by firearms and falls (National Trauma Data Bank 2016).
For children who reach a trauma center, firearms are the most lethal mechanism—the cause most likely to result in death.
The number of firearm deaths in the pediatric population now is about the same as at the beginning of this century, showing little progress.
Among pediatric firearm deaths by intent, homicides are most common, followed by suicide, then unintentional injuries.
In the 15-19 age group, firearms are responsible for 84% of homicides.
In the 15-19 age group, firearms are responsible for 46% of suicides.
In the 15-19 age group, 25% of all deaths involve a firearm.
Following Sandy Hook, the American Academy of Pediatrics, American College of Surgeons, and American Pediatric Surgical Association reviewed and updated their policy statements on firearm safety and injury prevention.
Eight organizations, including the American Academy of Pediatrics, American Academy of Family Physicians, American College of Surgeons, American Psychiatric Association, American Public Health Association, and American Bar Association, published a white paper in the Annals of Internal Medicine advocating multidisciplinary collaboration to reduce firearm injuries.
A survey of American College of Surgeons Committee on Trauma members showed that every advocacy topic related to firearms had over 50% support, and nearly half had over 90% support.
The American Pediatric Surgical Association submitted its firearm policy statement to the entire membership for review and discussion at the annual meeting, resulting in overwhelming approval.
Over the last 30-40 years, there has been a 17% reduction in motor vehicle-related deaths and a 77% increase in vehicle miles traveled, while firearm-related deaths increased by 15%.