For injured teens, pediatric trauma centers may be best

Injured teens treated at pediatric trauma centers are less likely to die than those treated at adult centers, a new study suggests.

Pediatric trauma centers have resources specialized to treat the anatomical and social needs of children, the authors write.

They had not expected to see any difference in mortality rates between injured adolescents treated at pediatric trauma centers versus adult trauma centers, said coauthor Dr. Randall S. Burd of the Children's National Medical Center in Washington, D.C.

And based on this one study, he told Reuters Health by email, "It is too premature to conclude that adolescents should preferentially be treated at pediatric trauma centers . . . . From a practical standpoint, pediatric trauma centers do not have the capacity to take on the care of all injured adolescents."

The researchers used the National Trauma Data Bank to study nearly 30,000 patients ages 15 to 19 who sustained a blunt injury or were cut, pierced or shot with a firearm in 2010.

In most parts of the U.S., severely injured patients are taken by ambulance and emergency medical services to a nearby trauma center based on their type of injury and age, using formalized criteria, Burd said.

More than two-thirds of the youngsters in this study were treated at an adult trauma center. Most of the rest were treated at mixed centers with pediatric and adult care options, while about 6 percent were treated at exclusively pediatric care centers.

More than 3 percent of those treated at adult or mixed trauma centers died, compared to less than 1 percent of those treated at pediatric centers, his team reported in JAMA Pediatrics.

The teens treated at pediatric centers tended to be younger, less severely injured, and more often sustained a blunt rather than a penetrating injury.

Only 19 percent of those treated at pediatric centers had been injured in a motor vehicle, compared to more than 30 percent of those treated at adult or mixed centers.

But even after taking these differences into account, "we observed that adolescent trauma patients have lower overall and in-hospital mortality when treated at pediatric trauma centers," the research team wrote.

"Although we controlled for severity of injury, it could be that patients treated at pediatric centers were less severely injured using measures of severity that were not available in our dataset," Burd told Reuters Health by email. "It could, however, be possible that type or quality of care received by adolescents at pediatric centers is better than at adult centers."

If care at pediatric centers does indeed differ from that at adult trauma centers, those differences should be identified to help optimize care for teens, he said.

SOURCE: http://bit.ly/28YS6BQ JAMA Pediatrics, online June 27, 2016.