Differences Between Pediatric & Adult Trauma Centers

This is Todd Ponsky from the Journal of Pediatric Surgery, and today we are at Cincinnati Children's Hospital in their trauma bay, and we are here with the director of trauma, Doctor Richard Falcone, who's professor of surgery here at Cincinnati Children's, and today he's going to do your two minute review. Hi everyone, I'm Rich Falcone, I'm professor of pediatric surgery at Cincinnati Children's, and today's article will be Pediatric and Adult Trauma Center Differ and evaluation, Treatment and Outcomes for Severely injured Adolescents by Ashley Walther etal. Um, this is a really interesting article to me and I admittedly biased as I'm, I'm one of the authors that participated in this, um, but it really takes a look at what's the difference for that adolescent age group between being cared for in an adult trauma center versus a pediatric trauma center. There's plenty of data that says pediatric trauma centers are certainly better for young kids, but that adolescent age, that 15 to 19 year olds are a little less less clear. This article specifically looked at age 15 to 19 and really was a follow up on a paper that looked at just Ohio that showed no difference in outcomes for this group whether they were treated at adult or pediatric trauma centers. This group now looked at the National Trauma Data Bank. The study included patients 15 to 19 and limited to only injury severity scores greater than 25, to really look at a severe injury group. Over a 5 year time span they found almost 13,000 patients that met those criteria, 51% of which were treated at adult trauma centers, the other 49 at pediatric trauma centers. Demographically, these groups were very similar without any significant differences. They all had severe injuries. The ISS scores median was 33 and 45% of them had a glass calcoma score of less than 8, being severe brain injuries. So these were seriously injured kids. What they found, the big picture, no significant difference in outcomes, no difference in mortality, whether those kids. Care for an adult or a pediatric trauma center, um, not surprising to those of us in the pediatric world, what we did find though was also that at the pediatric trauma center there was less imaging performed. Um, if you went to an adult trauma center, a kid was about 81% more likely to have an imaging study done. They had shorter length of stay, shorter ICU length of stay, and more discharges to home as opposed to rehab or skilled nursing facilities if they were cared for at a pediatric trauma center compared to an adult trauma center. Mortality again in this study, like the isolated Ohio study, there was no difference, but as we know, looking at mortality for pediatric trauma is not the most important or not a reliable outcome since fortunately once they reach a hospital, most kids survive. This article in conclusion, this article adds to the evidence that pediatric trauma centers add value for kids even up into that adolescent age range. Certainly more work will need to be done, um, bringing our adult counterparts to equivalent imaging and length of stays for these adolescents because clearly 51% are going to go to those hospitals anyway, so we need to get them up to speed with pediatric trauma centers. Thank you, Rich. I love that review. Uh, thank you for doing that. It seems to me that uh the, the biggest take home point from this was the difference in imaging and, and actually this is interesting because we just presented an article showing that for appendicitis that they're referring hospitals had higher imaging than in children's hospitals. Is that the big point here? I think, I think that is a big point for this uh paper is that we're able to take care of kids using less imaging and realizing that. You can trust your clinical diagnosis. You can trust your clinical exam and evaluating these kids, and they don't need that radiation exposure. Um, with less imaging, same outcomes, shorter length of stay, um, clearly proves to me that we can do this without radiating these kids. That's great. Thank you very much.