title: Treatment outcomes of injured children at adult level 1 trauma centers: are there benefits from added specialized care?
abstract: BACKGROUND
  Accidental traumatic injury is the leading cause of morbidity and mortality in children. The authors hypothesized that no mortality difference should exist between children seen at ATC (adult trauma centers) versus ATC with added qualifications in pediatrics (ATC-AQ).
  
  
  METHODS
  The National Trauma Data Bank, version 7.1, was analyzed for patients aged <18 years seen at level 1 trauma centers. Bivariate analysis compared patients by ATC versus ATC-AQ using demographic and injury characteristics. Multivariate analysis adjusting for injury and demographic factors was then performed.
  
  
  RESULTS
  A total sample of 53,702 children was analyzed, with an overall mortality of 3.9%. The adjusted odds of mortality was 20% lower for children seen at ATC-AQ (odds ratio, .80; 95% confidence interval, .68-.94). Children aged 3 to 12 years, those with injury severity scores > 25, and those with Glasgow Coma Scale scores < 8 all had significant reductions in the odds of death at ATC-AQ.
  
  
  CONCLUSIONS
  Improved overall survival is associated with pediatric trauma patients treated at ATC-AQ.
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC, USA. toyetunji@howard.edu
authors.forename: Tolulope A
authors.initials: TA
authors.lastname: Oyetunji
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Downing
authors.forename: Oluwaseyi B
authors.initials: OB
authors.lastname: Bolorunduro
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.forename: Suryanarayana M
authors.initials: SM
authors.lastname: Siram
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010372:Pediatrics / Q000458:organization & administration* / Q000706:statistics & numerical data; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*