title: Comparison of outcomes in severe pediatric trauma at adult trauma centers with different trauma case volumes.
abstract: BACKGROUND
  In addition to trauma center levels and types, trauma volume may be an important factor impacting outcomes in severe pediatric trauma.
  
  
  METHODS
  All severely injured pediatric patients treated at adult trauma centers were identified from the National Trauma Data Bank. All qualifying centers were stratified into four groups based on the cumulative pediatric trauma case volumes with ISS >15: lowest (group 1), lower (group 2), higher (group 3), and highest (group 4) volume centers. Mortality rates among the groups were compared.
  
  
  RESULTS
  A total of 3747 patients were stratified into group 1 (n=2122, median annual pediatric trauma volume 3 cases/year), group 2 (n=842, 15 cases/year), group 3 (n=494, 24 cases/year), and group 4 (n=289, 43 cases/year). In the hierarchical logistic regression analysis, the highest volume centers (group 4) were shown to have improved mortality (odds ratio 0.474, 95% confidence interval [CI] 0.301-0.747) compared to the lowest volume centers (group 1). Odds ratios of group 4 against group 1 for subgroups were 0.634 (age<10, 95% CI 0.335-1.198), 0.491 (blunt injury, 95% CI 0.310-0.777), and 0.495 (level 1 center, 95% CI 0.312-0.785).
  
  
  CONCLUSIONS
  In severe pediatric trauma treated at adult trauma centers, higher volume centers were associated with improved mortality in comparison to the lower volume centers.
  
  
  METHODS
  Level III, therapeutic/care management, retrospective comparative study without negative criteria.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Arrowhead Regional Medical Center, Colton, CA. Electronic address: drmiyatas@gmail.com.
authors.forename: Shin
authors.initials: S
authors.lastname: Miyata
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA. Electronic address: jayuncho11@gmail.com.
authors.forename: Jayun
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Surgery, Arrowhead Regional Medical Center, Colton, CA. Electronic address: hanna.s.park@gmail.com.
authors.forename: Hanna
authors.initials: H
authors.lastname: Park
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA. Electronic address: Kazuhide.Matsushima@med.usc.edu.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA. Electronic address: dbliss@chla.usc.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Bliss
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States; D014947:Wounds and Injuries / Q000145:classification / Q000401:mortality*; D014949:Wounds, Nonpenetrating / Q000401:mortality
keywords: Hierarchical logistic regression; Pediatric trauma; Trauma case volume; Trauma centers