title: Teen trauma without the drama: outcomes of adolescents treated at Ohio adult versus pediatric trauma centers.
abstract: BACKGROUND
  The optimal treatment facility for adolescent trauma patients is controversial. We sought to investigate risk-adjusted outcomes of adolescents treated at adult-only trauma centers (ATCs) versus pediatric-only trauma centers (PTCs) in a state system with legislated American College of Surgeons-verified institutions to determine ideal prehospital referral patterns.
  
  
  METHODS
  The Ohio Trauma Registry was queried for patients 15 years to 19 years with a length of stay (LOS) greater than 1 day at ATC (Level 1) or PTC (Levels 1 and 2) from 2008 to 2012. Race, sex, emergency department vital signs, Injury Severity Score (ISS), computed tomography, and ultrasound imaging were reviewed. Outcomes by mechanism of injury included ventilator days, intensive care unit LOS, hospital LOS, and mortality. Statistical analysis was performed using χ test, t test, and Wilcoxon rank-sum test. Propensity score-based risk adjustment matching was used to compare groups (propensity score within 0.01, ISS within 5).
  
  
  RESULTS
  Of 5,793 adolescents examined, (84% blunt, 16% penetrating) 66% were treated at an ATC. In unmatched comparisons, age, ISS, vital signs, and mortality differed significantly between centers (p < 0.01). For adolescents with blunt injury, more males (71.6% vs. 66.3%, p < 0.01) and nonwhites (19.2% vs. 15.8%, p < 0.01) were seen at PTCs. For penetrating trauma, more males (88.6% vs. 50.8%, p < 0.01) and nonwhites (66.4% vs. 34.3%, p < 0.01) were admitted to ATCs. In 873 propensity-matched pairs for blunt trauma and 95 propensity-matched pairs of penetrating injuries, no differences were seen in a priori outcomes. Imaging (blunt, head computed tomography and abdominal ultrasound, p < 0.01; penetrating, abdominal ultrasound, p = 0.02) was more common at ATCs.
  
  
  CONCLUSIONS
  Major outcome differences for injured adolescents do not exist between ATCs and PTCs, regardless of injury pattern. Imaging remains more prevalent at ATCs. In a state system with mandatory American College of Surgeons-verified centers, injury patterns need not dictate triage decisions for adolescents.
  
  
  METHODS
  Epidemiologic study, level III.
authors: From the Division of Trauma/Critical Care (A.E.W., T.A.P., D.J.H., B.R.H.R.), and Division of Pediatric General and Thoracic Surgery (R.A.F.), Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
authors: Ashley E
authors: AE
authors: Walther
authors: Timothy A
authors: TA
authors: Pritts
authors: Richard A
authors: RA
authors: Falcone
authors: Dennis J
authors: DJ
authors: Hanseman
authors: Bryce R H
authors: BR
authors: Robinson
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D009820:Ohio; D017063:Outcome Assessment, Health Care; D057216:Propensity Score; D012042:Registries; D014193:Trauma Centers / Q000458:organization & administration; D014949:Wounds, Nonpenetrating / Q000628:therapy; D014950:Wounds, Penetrating / Q000628:therapy