title: 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.
abstract: BACKGROUND
  Optimal management of adolescent trauma patients with blunt abdominal solid organ injury (SOI) remains controversial. The purpose of this study was to identify management differences in adolescents with SOI treated at adult trauma centers (ATC) versus pediatric trauma centers (PTC). We hypothesized that adolescents with SOI would undergo different treatment at ATC and PTC.
  
  
  METHODS
  Retrospective review of the Pennsylvania Trauma Systems Foundation database from 2005-2010 was performed. Adolescent patients (13-18 y old) with SOI (spleen, liver, and kidney injury) were included. Patient baseline characteristics and care processes for each injury were compared between ATC and PTC.
  
  
  RESULTS
  A total of 1532 patients with at least one SOI were identified: 946 patients had a splenic injury, 505 had a liver injury, and 424 had a kidney injury. Spleen and liver procedures were performed more often at ATC than at PTC irrespective of injury grade (respectively, 16.1% versus 3.2%, 5.9% versus 0%; P < 0.01). Transarterial embolization for splenic injury was more frequently performed at ATC (2.8% versus 0.6%; P = 0.02). After adjusting for potential confounding factors, care at PTC was significantly associated with lower odds of splenic procedure for patients with splenic injury (OR: 0.16, 95% CI: 0.08-0.36, P < 0.001). In a subgroup analysis of nontransfer patients, care at PTC remained significantly associated with lower odds of splenic procedure (OR: 0.24, 95% CI: 0.10-0.59, P = 0.002) despite higher median injury severity score than ATC.
  
  
  CONCLUSIONS
  Significant differences in the management of adolescents with SOI were identified in Pennsylvania. Operative intervention for SOI was more often performed at ATC than at PTC. Further study will be needed to address the impact of these disparities on patient outcomes.
authors.affiliation: Division of Trauma, Acute Care and Critical Care Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA 17036, USA. kmatsushima@hmc.psu.edu
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.forename: Afif N
authors.initials: AN
authors.lastname: Kulaylat
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Won
authors.forename: Audrey L
authors.initials: AL
authors.lastname: Stokes
authors.forename: Eric W
authors.initials: EW
authors.lastname: Schaefer
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Frankel
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology / Q000601:surgery*; D000293:Adolescent; D016208:Databases, Factual / Q000706:statistics & numerical data*; D019468:Disease Management; D005260:Female; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000293:injuries / Q000601:surgery; D008099:Liver / Q000293:injuries / Q000601:surgery; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries / Q000601:surgery; D014193:Trauma Centers / Q000145:classification* / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000601:surgery*
keywords: Adolescent trauma; Adult trauma center; Blunt abdominal solid organ injury; Pediatric trauma center