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In children aged 12 to 16 years with traumatic injury, admission to a pediatric trauma center was not associated with improved hospital mortality compared to admission to an adult trauma center.
Are adolescents just big kids? Or small adults?
While evidence has shown that organized trauma systems can reduce mortality and morbidity in injured children, there is conflicting evidence regarding where adolescents, who are closer in age to adults, should be treated. While studies have shown that for all children, admission to pediatric trauma centers was associated with lower odds of mortality, these differences did not persist in subgroup analyses of adolescents 14 years or older.
This retrospective cohort study investigated whether pediatric trauma center admission improved mortality outcomes for severely injured adolescents (aged 12–16 years) compared to adult trauma centers. Among 416 patients, 7% died at pediatric centers versus 4.2% at adult centers, with no significant difference in hospital mortality (adjusted OR 2.61, 95%CI 0.88–7.69; p=0.08). Findings suggest adolescents may be safely managed at either adult or pediatric trauma centers, emphasizing resource availability and transport efficiency. The study was unable to evaluate long-term physical or psychological disability, both areas that might be impacted by admission to a pediatric trauma center.
How will this change my practice?
Given the recent study on the impact of pediatric readiness in the emergency department, it is reassuring that the results of this study suggest that adolescents can be safely managed at either a pediatric or adult trauma center. I think the limitation regarding morbidity is an area that must be explored; it would be reasonable to think that pediatric trauma centers would have family-centered and specialized psychological support that would be more appropriate for children. Future studies can hopefully focus on these outcomes to optimize both mortality and morbidity for adolescents after a traumatic injury.
Source
Mortality Among Severely Injured Adolescents Admitted to Pediatric vs Adult Trauma Centers. JAMA Netw Open. 2024 Dec 2;7(12):e2450647. doi: 10.1001/jamanetworkopen.2024.50647. PMID: 39666336
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Dr. Joshua Belfer, MD, is a Pediatric Emergency Medicine physician at the Children’s Hospital of Philadelphia, and is the Founder and Editor-in-Chief of HipPEMcrates. He can be reached at HipPEMcrates@gmail.com.
