Success in the national care of pediatric trauma patients

Background: Pediatric trauma patients should be treated at pediatric trauma centers, though not every patient can be transported to one. Our goal was to report outcomes for trauma patients at centers of varying levels of verification by the American College of Surgeons (ACS). Materials and Methods: Retrospective review of the ACS Trauma Quality Improvement Program trauma registry data of patients (<15 years old) receiving care at trauma centers in the United States. We compared level 1 and 2 pediatric trauma centers (PTC1 and PTC2) and level 1, 2 and 3 adult trauma centers (TC1, TC2, TC3). Main outcome measure was mortality. Secondary measures were injury severity score (ISS), length of stay (LOS), 30-day complications and race/ethnicity. We also stratified by trauma severity (non-severe vs severe ISS >= 15), and age groups (0-3, 3-10, 10-15). Results: 41,399 patients met our inclusion criteria: 37,624 blunt, 3,775 penetrating. Of all patients, 66.7 % were treated at a PTC (69.9 % PTC1, 30.1 % PTC2), and 1.6 % of trauma resulted in mortality. Mortality rate (the percentage of cases treated that resulted in mortality) by trauma center varied more for penetrating trauma (range: 2.1-8.0) than for blunt trauma (range: 0.9-1.7). For blunt trauma, 46.6 % were treated at PTC1s and 1.3 % resulted in mortality. The highest mean ISS and length of stay were at TC1s. For penetrating trauma, 47.5 % were treated at PTC1s and 5.0 % resulted in mortality. Most traumas were non-severe and mortality rates for penetrating trauma were higher for the 10-15 age group, though still lower at pediatric trauma centers. Conclusion: The majority of pediatric trauma patients were treated at a PTC with slightly better outcomes than TCs. Overall, treatment at PTCs resulted in slightly lower mortality rates, shorter LOS, and lower/equivalent 30-day complication rates.