title: Trauma experts versus pediatric experts: comparison of outcomes in pediatric penetrating injuries.
abstract: While pediatric trauma centers (PTCs) can uniquely care for pediatric patients, adult trauma centers (ATCs) may be more accessible. Evidence is scarce regarding outcomes of pediatric patients with penetrating trauma treated at PTCs versus ATCs.
  
  
  
  We performed a retrospective study using the National Trauma Data Bank to identify pediatric patients aged ≤18 y with penetrating injuries from 2007 to 2012, treated at stand-alone PTCs or ATCs. We excluded patients treated at combined PTC or ATC, transferred between hospitals, with gunshot wounds (GSW) to the head, or dead on arrival. Eligible patients numbered 26,276 (PTC, n = 3737; ATC, n = 22,539). The primary outcome was in-hospital mortality. The secondary outcome was discharge location as a potential surrogate for functional outcome. Univariate and multivariate analyses assessed trauma center type as an independent risk factor for outcomes.
  
  
  
  Patients treated at ATCs were more likely to have Injury Severity Score >15, Glasgow Coma Scale <9, GSW, cardiovascular injuries, and emergent operations (P < 0.001). Adjusted odds ratios (ORs) for mortality favored PTCs but without statistical significance (OR, 0.592; P = 0.054). In subgroup analyses, children with aged ≤12 y, those with GSW injury mechanism, and those who underwent emergent operations at PTCs were more frequently discharged home versus elsewhere (OR, 0.327, 0.483, and 0.394; P values <0.001, <0.001, and 0.004, respectively).
  
  
  
  Children with penetrating injuries demonstrated equivalent survival outcomes whether they were treated at PTCs or ATCs. Younger pediatric patients may have superior functional outcomes when treated at PTCs.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California. Electronic address: drmiyatas@gmail.com.
authors.forename: Shin
authors.initials: S
authors.lastname: Miyata
authors.affiliation: Department of Surgery, University of Southern California, Los Angeles, California.
authors.forename: Jayun
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Olga
authors.initials: O
authors.lastname: Lebedevskiy
authors.affiliation: Department of Surgery, University of Southern California, Los Angeles, California.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.affiliation: Department of Surgery, Arrowhead Regional Medical Center, Colton, California.
authors.forename: Esther
authors.initials: E
authors.lastname: Bae
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: David W
authors.initials: DW
authors.lastname: Bliss
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000628:therapy*
keywords: Adult trauma center; Mortality; Pediatric trauma; Pediatric trauma center; Penetrating injury