Comparison of pediatric motor vehicle collision injury outcomes at Level I trauma centers

Abstract

ObjectiveExamine the association of American College of Surgeons Level I pediatric trauma center designation with outcomes of pediatric motor vehicle collision-related injuries. MethodsObservational study of the 2009–2012 National Trauma Data Bank, including n=28,145 patients <18years directly transported to a Level I trauma center. Generalized estimating equations estimated odds ratios (ORs) for injury outcomes, comparing freestanding pediatric trauma centers (PTCs) with adult centers having added Level I pediatric qualifications (ATC+PTC) and general adult trauma centers (ATC). Models were stratified by age following PTC designation guidelines, and adjusted for demographic and clinical risk factors. ResultsAnalyses included n=16,643 children <15 and n=11,502 adolescents 15–17years. Among children, odds of laparotomy (OR=1.88, 95% CI 1.28–2.74) and pneumonia (OR=2.13, 95% CI 1.32–3.46) were greater at ATCs vs. freestanding PTCs. Adolescents treated at ATC+PTCs or ATCs experienced greater odds of death (OR=2.18, 95% CI 1.30–3.67; OR=1.98, 95% CI 1.37–2.85, respectively) and laparotomy (OR=4.33, 95% CI 1.56–12.02; OR=5.11, 95% CI 1.92–13.61, respectively). ConclusionsCompared with freestanding PTCs, children treated at general ATCs experienced more complications; adolescents treated at ATC+PTCs or general ATCs had greater odds of death. Identification and sharing of best practices among Level I trauma centers may reduce variation in care and improve outcomes for children.