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Do Pediatric Trauma Centers Have Better Survival Rates than Adult Trauma Centers? An Examination of the National Pediatric Trauma Registry

Osler, Turner M. MD, FACS; Vane, Dennis W. MD, FACS; Tepas, Joseph J. MD, FACS; Rogers, Frederick B. MD, FACS; Shackford, Steven R. MD, FACS; Badger, Gary J. MS

The Journal of Trauma: Injury, Infection, and Critical Care: January 2001 - Volume 50 - Issue 1 - p 96-101
Article Titles

Background Pediatric trauma centers (PTCs) were developed to improve the survival of injured children, but it is currently unknown if children admitted to PTCs are more likely to survive than those admitted to adult trauma centers (ATCs).

Methods Fifty-three thousand one hundred thirteen pediatric trauma cases from 22 PTCs and 31 ATCs included in the National Pediatric Trauma Registry were reviewed to evaluate survival rates at PTCs and ATCs.

Results Overall, 1,259 children died. The raw mortality rate was lower at PTCs (1.81% of 32,554 children) than at ATCs (3.88% of 18,368 children). However, patients admitted to ATCs were more severely injured. When Injury Severity Score, Pediatric Trauma Score, mechanism (blunt or penetrating), gender, age, clustering, and American College of Surgeons (ACS) verification status were controlled for using a single logistic regression model, there was no statistically significant difference in survival between PTCs and ATCs (odds ratio, 1.02; 95% confidence interval, 0.83–1.26;p = 0.587). A similar comparison of the 12 ACS-verified trauma centers with the 41 nonverified centers showed verification to be associated with improved survival (odds ratio, 0.75; 95% confidence interval, 0.58–0.97;p = 0.013).

Conclusion Although PTCs have higher overall survival rates than ATCs, this difference disappears when the analysis controls for Injury Severity Score, Pediatric Trauma Score, age, mechanism, and ACS verification status. ACS-verified centers have significantly higher survival rates than do unverified centers.

From the University of Vermont (T.M.O., D.W.V., F.B.R., S.R.S., G.J.B.), Fletcher Health Care Center, Burlington, Vermont and the Department of Surgery (J.J.T.), University of Florida, Jacksonville, Florida.

Submitted for publication September 26, 1998.

Accepted for publication October 6, 2000.

Presented at the 58th Annual Meeting of the American Association for the Surgery of Trauma, September 24–26, 1998, Baltimore, Maryland.

Address for reprints: Turner M. Osler, MD, University of Vermont, Fletcher Allen Health Care, 111 Colchester Avenue, FL 466, MCHV Campus, Burlington, VT 05401; email: turner.osler@vtmednet.org.

© 2001 Lippincott Williams & Wilkins, Inc.