title: Pediatric trauma mortality by type of designated hospital in a mature inclusive trauma system.
abstract: BACKGROUND
  Previous studies have shown divergent results regarding the survival of injured children treated at pediatric trauma centers (PTC) and adult trauma centers (ATC).
  
  
  OBJECTIVE
  (1) To document, in a regionalized inclusive trauma system, at which level of trauma centers were the injured children treated and (2) to compare the in-hospital mortality over five levels of trauma care, ranging from pediatric level I trauma centers (PTC) to designated local trauma hospitals (level IV) for the whole study sample and for subgroups of severely injured children and head trauma.
  
  
  METHODS
  A retrospective analysis included data on 11,053 injured children (age ≤16 years) treated between April 1998 and March 2005 in 58 designated trauma hospitals in the province of Quebec, Canada. Multiple imputation was used to handle missing physiological data and multivariate logistic regression was used to compare mortality over levels of care.
  
  
  RESULTS
  PTC treated 52.2% of the children. Children treated at PTC were more often transferred from another hospital (73%) and were more severely injured. ATC level I, II, III and IV centers treated, respectively, 3.0%, 16.2%, 24.3% and 4.3% of children. Compared with children treated at a PTC, the risk of mortality was higher for children treated at each other ATC, i.e. level I (adjusted odds ratio [OR] = 3.1; 95% confidence interval [CI]: 1.3-7.5), level II (OR = 2.5; 95% CI: 1.3-5.0), level III (OR = 5.2; 95% CI: 2.1-13.1) and level IV (OR = 9.9; 95% CI: 2.4-41.3). Similar findings were observed among the subsamples of children who were more severely injured (Injury Severity Score >15) and who sustained head injuries.
  
  
  CONCLUSIONS
  In our trauma system, PTC cared for more than half of the injured children and patients treated there have better survival than those treated at all other levels of ATC.
authors.affiliation: Unit of Traumatology, Emergency Medicine and Intensive Care, Research Centre of CHA (Enfant-Jésus Hospital), Quebec (QC), Canada.
authors.forename: Rachid
authors.initials: R
authors.lastname: Amini
authors.forename: André
authors.initials: A
authors.lastname: Lavoie
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Sirois
authors.forename: Marcel
authors.initials: M
authors.lastname: Emond