title: Comparison of pediatric motor vehicle collision injury outcomes at Level I trauma centers.
abstract: OBJECTIVE
  Examine the association of American College of Surgeons Level I pediatric trauma center designation with outcomes of pediatric motor vehicle collision-related injuries.
  
  
  METHODS
  Observational study of the 2009-2012 National Trauma Data Bank, including n=28,145 patients <18years directly transported to a Level I trauma center. Generalized estimating equations estimated odds ratios (ORs) for injury outcomes, comparing freestanding pediatric trauma centers (PTCs) with adult centers having added Level I pediatric qualifications (ATC+PTC) and general adult trauma centers (ATC). Models were stratified by age following PTC designation guidelines, and adjusted for demographic and clinical risk factors.
  
  
  RESULTS
  Analyses included n=16,643 children <15 and n=11,502 adolescents 15-17years. Among children, odds of laparotomy (OR=1.88, 95% CI 1.28-2.74) and pneumonia (OR=2.13, 95% CI 1.32-3.46) were greater at ATCs vs. freestanding PTCs. Adolescents treated at ATC+PTCs or ATCs experienced greater odds of death (OR=2.18, 95% CI 1.30-3.67; OR=1.98, 95% CI 1.37-2.85, respectively) and laparotomy (OR=4.33, 95% CI 1.56-12.02; OR=5.11, 95% CI 1.92-13.61, respectively).
  
  
  CONCLUSIONS
  Compared with freestanding PTCs, children treated at general ATCs experienced more complications; adolescents treated at ATC+PTCs or general ATCs had greater odds of death. Identification and sharing of best practices among Level I trauma centers may reduce variation in care and improve outcomes for children.
authors.affiliation: Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue, Minneapolis, MN 55404. Electronic address: jill_dreyfus@premierinc.com.
authors.forename: Jill
authors.initials: J
authors.lastname: Dreyfus
authors.affiliation: Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue, Minneapolis, MN 55404.
authors.forename: Andrew
authors.initials: A
authors.lastname: Flood
authors.affiliation: Department of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue, Minneapolis, MN 55404.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Cutler
authors.affiliation: Department of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue, Minneapolis, MN 55404.
authors.forename: Henry
authors.initials: H
authors.lastname: Ortega
authors.affiliation: Department of Pediatric Surgery, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue, Minneapolis, MN 55404.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kreykes
authors.affiliation: Department of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue, Minneapolis, MN 55404.
authors.forename: Anupam
authors.initials: A
authors.lastname: Kharbanda
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D014193:Trauma Centers; D014481:United States; D014947:Wounds and Injuries / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy
keywords: Level I trauma center; Motor vehicle collision; Pediatric trauma center; Trauma