title: Pediatric and adult trauma centers differ in evaluation, treatment, and outcomes for severely injured adolescents.
abstract: OBJECTIVE
  This study aims to investigate differences in imaging, procedure utilization, and clinical outcomes of severely injured adolescents treated at adult versus pediatric trauma centers.
  
  
  METHODS
  The National Trauma Data Bank was queried retrospectively for adolescents, 15-19years old, with a length of stay (LOS) >1day and Injury Severity Score (ISS) >25 treated at adult (ATC) or pediatric (PTC) Level 1 trauma centers from 2007 to 2011. Patient demographics and utilization of imaging and procedures were analyzed. Univariate and multivariate regression analysis was used to compare outcomes.
  
  
  RESULTS
  Of 12,861 adolescents, 51% were treated at ATC. Older age and more nonwhites were seen at ATC (p<0.01). Imaging and invasive procedures were more common at ATC (p<0.01). Shorter LOS (p=0.03) and higher home discharge rates (p<0.01) were seen at PTC. ISS and mortality did not differ. Age, race, ATC care (all p<0.01), and admission systolic blood pressure (SBP) (p=0.03) were predictors of CT utilization. ISS, SBP, and race (p<0.01) were risk factors for overall mortality; SBP (p=0.03) and ISS (p<0.01) predicted death from penetrating injury.
  
  
  CONCLUSIONS
  Severely injured adolescents experience improved outcomes and decreased imaging and invasive procedures without additional mortality risk when treated at PTC. PTC is an appropriate destination for severely injured adolescents.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati College of Medicine, USA. Electronic address: waltheay@uc.edu.
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Walther
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati College of Medicine, USA. Electronic address: richard.falcone@cchmc.org.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Falcone
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati College of Medicine, USA. Electronic address: prittsta@uc.edu.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Pritts
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati College of Medicine, USA. Electronic address: hansemdj@uc.edu.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.affiliation: Division of Trauma, Critical Care, and Burns, Department of Surgery, University of Washington, USA. Electronic address: brobinso@uw.edu.
authors.forename: Bryce R H
authors.initials: BR
authors.lastname: Robinson
mesh_terms: D000293:Adolescent; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
keywords: Adolescents; Adult trauma center; Imaging; Pediatric trauma center; Trauma outcomes