260 Pediatric Penetrating Head Trauma: Do Children Need to be Taken to Pediatric Trauma Centers?

Abstract

INTRODUCTION: Gun violence has become the leading cause of death in children. Debate exists regarding the optimal treatment setting for pediatric trauma patients at either Adult Trauma Centers (ATC) or Pediatric Trauma Centers (PTC). METHODS: A retrospective analysis of the National Trauma Data Bank (NTDB) was performed from 2017-2020. Inclusion criteria included age 18 years or younger, firearm related mechanism, and associated ICD-10 code corresponding to intracranial injury. Patient characteristics and outcomes were compared across groups. RESULTS: 2,662 cases met inclusion criteria. Overall mortality was 52.1%. 57.4% of patients presented to ATC, 12.8% to PTC, and 29.7% to dual-certified centers. The median age of patients treated at ATC was 17, 13 at PTC, and 16 at dual-certified centers. While mortality was lower for patients presenting to PTC relative to ATC and dual-certified centers (38.2% vs. 55.6% vs. 52.9%, respectively, p < 0.001), PTC patients had higher GCS scores (7.8 vs. 6.5 vs. 6.7, p < 0.001) and lower rates of bilaterally fixed and dilated pupils at presentation (38.9% vs 53% vs 6.7%, p < 0.001). In a logistic regression analysis controlling for baseline pupillary response, GCS, age, ISS, and treatment center type, no significant association was seen between center type and mortality (p = 0.550). CONCLUSIONS: Although mortality was significantly higher for patients presenting to ATC, when baseline injury severity was controlled for, no statistically significant effect was seen with respect to mortality. These results show that the bulk of pediatric GSW are already being treated at ATC and suggest that there is no significant difference in mortality relative to PTC.