Impact of pediatric trauma centers on mortality in a statewide system

Background: Regional pediatric trauma centers (PTC) were established to opt imize the care of injured children, However, because of the relative shorta ge of PTC, many injured children continue to be treated at adult trauma cen ters (ATC), As a result, a growing controversy has evolved regarding the im pact of PTC and ATC on outcome for injured children. Methods: A retrospective analysis of 13,351 injured children entered in the Pennsylvania Trauma Outcome Study between 1993 and 1997 was conducted. Pat ients were stratified according to mechanism of injury, injury severity, sp ecific organ injury, and type of trauma center: PTC; Level I ATC (ATC I); L evel LI ATC (ATC II); or ATC with added qualifications to treat children (A TC AQ), Mortality was the major outcome variable measured, Results:Most injured children were treated at a PTC or ATC AQ, The majority of children below 10 years of age were admitted to PTC, Patients treated a t PTC and ATC had similar injury severity as determined by median Injury Se verity Score, mean Revised Trauma Score, and Glasgow Coma Scale. Overall su rvival was significantly better at PTC and ATC AQ compared with ATC I and A TC II. Survival for head, spleen, and liver injuries was significantly bett er at PTC compared with ATC AQ, ATC I, or ATC II. Children who sustained mo derate or severe head injuries were more likely to undergo neurosurgical in tervention and have a better outcome when treated at a PTC, Despite similar mean Abbreviated Injury Scores for spleen and liver, significantly more ch ildren underwent surgical exploration (especially splenectomy) for spleen a nd liver injuries at ATC compared with PTC, Conclusion: Children treated at PTC or ATC AQ have significantly better out come compared with those treated at ATC, Severely injured children (Injury Severity Score > 15) with head, spleen, or liver injuries had the best over all outcome when treated at PTC, This difference in outcome may be attribut able to the approach to operative and nonoperative management of head, live r, and spleen injuries at PTC.