Pediatric versus adult paradigms for management of adolescent injuries within a regional trauma system
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In brief
In brief
This retrospective study compared outcomes for adolescents (15-17 years) treated at pediatric versus adult trauma centers within one regional system. Adult centers used CT scanning more frequently and provided less neuropsychological follow-up for minor TBI, while management of solid organ injuries and femur fractures showed minimal differences when controlling for injury severity.
Written by the GCMD Library team from the article.
Abstract
Background
We aimed to examine process and outcome indicators for adolescents with specific injury patterns managed in pediatric versus adult paradigms within the same trauma system.
Methods
Adolescents (15–17 years old) admitted to the region's adult trauma center (ATC) or pediatric trauma center (PTC) with an abdominal injury, femur fracture or traumatic brain injury (TBI) were reviewed retrospectively. Global and injury-specific process and outcome indicators were compared.
Results
Of 141 ATC and 69 PTC patients, injury patterns differed significantly with more TBI and abdominal injuries at the ATC and femur fractures at the PTC. Overall injury severity was greater at the ATC. Patients with solid organ injuries appeared more likely to undergo embolization or splenectomy at the ATC; however, higher injury grade and later time period were the only variables significantly associated with this. Computed tomography (CT) was used significantly more frequently at the ATC overall, most notable with panscanning and head CTs for major TBI. Time to operative management did not differ for patients with isolated femur fractures. Neuropsychological follow up after minor TBI was documented more often at the PTC than the ATC; there was no difference for those with more severe TBIs.
Conclusions
Management varies for adolescents between PTCs and ATCs with more exposure to radiation and less neuropsychological follow-up of less severe TBIs at the ATC. This presents distinct opportunities to identify best policies for triage and sharing of management practices within a single regional inclusive trauma system in order to optimize short and long-term outcomes for this population.
Type of study
Retrospective cohort.
Level of evidence
Level IV.