THE RELATIONSHIP BETWEEN CENTER TYPE AND MORTALITY AMONG ADOLESCENT TRAUMA PATIENTS

Importance: Although improved outcomes for children treated at pediatric (PTC) compared to adult trauma centers (ATC) have been observed, differences in mortality have not been consistently observed for adolescents using data obtained from regional trauma systems. Because trauma is the leading cause of death and acquired disability among adolescents, it is important to better define differences in outcome among injured adolescents using national data. Objective: To use a national dataset to compare mortality of injured adolescents at different trauma center types: ATC, PTC, or mixed trauma centers (MTC) that treat both pediatric and adult trauma patients. Design: Multilevel models accounting for center-specific effects were used to evaluate the association of center characteristics (PTC, ATC or mixed [MTC]) on mortality, controlling for gender, mechanism of injury (blunt vs. penetrating), injuries sustained based on Abbreviated Injury Scale (post-dot values <3 or ≥3 by body region), initial systolic blood pressure, and Glasgow coma scale. Missing data was managed using multiple imputation, accounting for multilevel data structure. Setting: Level I or level II trauma centers participating in the National Trauma Data Bank Address correspondence: Randall S. Burd, MD, PhD, Division of Trauma and Burn Surgery, Joseph E. Robert, Jr. Center for Surgical Care, Children’s National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, 202-476-2151 phone, 202-476-6704 fax, rburd@childrensnational.org. HHS Public Access Author manuscript JAMA Pediatr. Author manuscript; available in PMC 2021 March 23. Published in final edited form as: JAMA Pediatr. 2016 August 01; 170(8): 780–786. doi:10.1001/jamapediatrics.2016.0805. A uhor M anscript