Pediatric and adult trauma centers differ in evaluation, treatment, and outcomes for severely injured adolescents

被引：55

作者：

Walther, Ashley E. ^{[1
]}

Falcone, Richard A. ^{[2
]}

Pritts, Timothy A. ^{[1
]}

Hanseman, Dennis J. ^{[1
]}

Robinson, Bryce R. H. ^{[3
]}

机构：

[1] Univ Cincinnati, Coll Med, Dept Surg, Div Trauma & Crit Care, Cincinnati, OH 45221 USA

[2] Univ Cincinnati, Coll Med, Cincinnati Childrens Hosp Med Ctr, Div Pediat Gen & Thorac Surg,Dept Surg, Cincinnati, OH 45221 USA

[3] Univ Washington, Dept Surg, Div Trauma Crit Care & Burns, Seattle, WA 98195 USA

来源：

JOURNAL OF PEDIATRIC SURGERY | 2016年 / 51卷 / 08期

关键词：

Pediatric trauma center; Adult trauma center; Adolescents; Trauma outcomes; Imaging; FOCUSED ABDOMINAL SONOGRAPHY; COMPUTED-TOMOGRAPHY; RADIATION-EXPOSURE; BLUNT TRAUMA; MORTALITY-RATES; CT EXAMINATIONS; CHILDREN; RISK; PATIENT; CARE;

D O I：

10.1016/j.jpedsurg.2016.03.016

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Background/purpose: This study aims to investigate differences in imaging, procedure utilization, and clinical outcomes of severely injured adolescents treated at adult versus pediatric trauma centers. Methods: The National Trauma Data Bank was queried retrospectively for adolescents, 15-19 years old, with a length of stay (LOS) >1 day and Injury Severity Score (ISS) >25 treated at adult (ATC) or pediatric (PTC) Level 1 trauma centers from 2007 to 2011. Patient demographics and utilization of imaging and procedures were analyzed. Univariate and multivariate regression analysis was used to compare outcomes. Results: Of 12,861 adolescents, 51% were treated at ATC. Older age and more nonwhites were seen at ATC (p < 0.01). Imaging and invasive procedures were more common at ATC (p < 0.01). Shorter LOS (p = 0.03) and higher home discharge rates (p < 0.01) were seen at PTC. ISS and mortality did not differ. Age, race, ATC care (all p < 0.01), and admission systolic blood pressure (SBP) (p = 0.03) were predictors of CT utilization. ISS, SBP, and race (p < 0.01) were risk factors for overall mortality; SBP (p = 0.03) and ISS (p < 0.01) predicted death from penetrating injury. Conclusions: Severely injured adolescents experience improved outcomes and decreased imaging and invasive procedures without additional mortality risk when treated at PTC. PTC is an appropriate destination for severely injured adolescents. (C) 2016 Elsevier Inc. All rights reserved.

引用

页码：1346 / 1350

页数：5

共 40 条

[11] Chest computed tomography imaging for blunt pediatric trauma: not worth the radiation risk [J].

Holscher, Courtenay M. ;

Faulk, Leonard W. ;

Moore, Ernest E. ;

Burlew, Clay Cothren ;

Moore, Hunter B. ;

Stewart, Camille L. ;

Pieracci, Fredric M. ;

Barnett, Carlton C. ;

Bensard, Denis D. .

JOURNAL OF SURGICAL RESEARCH, 2013, 184 (01) :352-357

[12] Triage of Children with Moderate and Severe Traumatic Brain Injury to Trauma Centers [J].

Kernic, Mary A. ;

Rivara, Frederick P. ;

Zatzick, Douglas F. ;

Bell, Michael J. ;

Wainwright, Mark S. ;

Groner, Jonathan I. ;

Giza, Christopher C. ;

Mink, Richard B. ;

Ellenbogen, Richard G. ;

Boyle, Linda ;

Mitchell, Pamela H. ;

Kannan, Nithya ;

Vavilala, Monica S. .

JOURNAL OF NEUROTRAUMA, 2013, 30 (13) :1129-1136

[13] Analysis of radiation exposure among pediatric trauma patients at national trauma centers [J].

Kharbanda, Anupam B. ;

Flood, Andrew ;

Blumberg, Karen ;

Kreykes, Nathan S. .

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2013, 74 (03) :907-911

[14] Influence of patient age on normalized effective doses calculated for CT examinations [J].

Khursheed, A ;

Hillier, MC ;

Shrimpton, PC ;

Wall, BF .

BRITISH JOURNAL OF RADIOLOGY, 2002, 75 (898) :819-830

[15] Splenic conservation: Variation between pediatric and adult trauma centers [J].

Lippert, Sarah J. ;

Hartin, Charles W., Jr. ;

Ozgediz, Doruk E. ;

Glick, Philip L. ;

Caty, Michael G. ;

Flynn, William J. ;

Bass, Kathryn D. .

JOURNAL OF SURGICAL RESEARCH, 2013, 182 (01) :17-20

[16] Variation in the management of adolescent patients with blunt abdominal solid organ injury between adult versus pediatric trauma centers: an analysis of a statewide trauma database [J].

Matsushima, Kazuhide ;

Kulaylat, Afif N. ;

Won, Eugene J. ;

Stokes, Audrey L. ;

Schaefer, Eric W. ;

Frankel, Heidi L. .

JOURNAL OF SURGICAL RESEARCH, 2013, 183 (02) :808-813

[17]

Matsushima K, 2013, AM SURGEON, V79, P267

[18] Hepatoblastoma imaging with gadoxetate disodium-enhanced MRI-typical, atypical, pre- and post-treatment evaluation [J].

Meyers, Arthur B. ;

Towbin, Alexander J. ;

Geller, James I. ;

Podberesky, Daniel J. .

PEDIATRIC RADIOLOGY, 2012, 42 (07) :859-866

[19] The Use of Computed Tomography in Pediatrics and the Associated Radiation Exposure and Estimated Cancer Risk [J].

Miglioretti, Diana L. ;

Johnson, Eric ;

Williams, Andrew ;

Greenlee, Robert T. ;

Weinmann, Sheila ;

Solberg, Leif I. ;

Feigelson, Heather Spencer ;

Roblin, Douglas ;

Flynn, Michael J. ;

Vanneman, Nicholas ;

Smith-Bindman, Rebecca .

JAMA PEDIATRICS, 2013, 167 (08) :700-707

[20] Pediatric Radiation Exposure During the Initial Evaluation for Blunt Trauma [J].

Mueller, Deborah L. ;

Hatab, Mustapha ;

Al-Senan, Rani ;

Cohn, Stephen M. ;

Corneille, Michael G. ;

Dent, Daniel L. ;

Michalek, Joel E. ;

Myers, John G. ;

Wolf, Steven E. ;

Stewart, Ronald M. .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2011, 70 (03) :724-730

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