CINCINNATI—In the minutes after a traumatic injury involving a teenager, two things may be unclear—the exact age of the patient and the best place to send them: the local pediatric trauma center or the local adult trauma center.
After a review of outcomes from both types of centers in Ohio, investigators in the UC Division of Trauma and Critical Care can report that, for certain states, teen patients have generally the same outcomes at either type of facility.
Senior author Bryce Robinson MD, a UC Health trauma surgeon and associate professor of surgery, says that’s a good thing for our community. He also says the topic is controversial within the larger medical community.
"In Cincinnati, Columbus, Dayton—these big, urban areas—we see a lot of adolescent patients who have the option to go to a Level I or Level II pediatric trauma center or equivalent level adult trauma center,” he says. "At University of Cincinnati Medical Center, our minimum age is 15 years old, but we can easily get younger adolescents in the emergency department after a bad injury. There’s a large gray zone for these patients—and we didn’t know if there was any differences in their outcomes.”
Working with third-year resident Ashley Walther, MD, Robinson and colleagues sought to compare risk-adjusted outcomes for adolescents treated at adult-only trauma centers (ATCs) versus pediatric-only trauma centers (PTCs) in Ohio—a state with legislation requiring that all trauma centers be verified by the American College of Surgeons.
They reviewed cases in the Ohio Trauma Registry from 2008 to 2012 in which a 15- to 19-year-old patient stayed longer than one day at an ATC or PTC. Their analysis included emergency department vital signs and a severity of injury score, as well as outcome markers such as length of hospital stay, length of time on a ventilator and overall mortality rates.
Of the 5,793 adolescent patient cases examined, (84 percent blunt trauma, 16 percent penetrating trauma) two-thirds were treated at an adult trauma center, with more severe penetrating injuries taken to ATCs than PTCs. Using matched comparison, the team found no major difference in outcomes for injured adolescents admitted to ATCs or PTCs, regardless of their type of injury pattern.
Walther says the limitations to their study include not being able to compare more specific outcome details, like patient satisfaction measurements or patients’ functional status and direction after discharge (e.g., did a patient go home or to a rehabilitation center after the hospital?).
Robinson also notes that their results are not necessarily generalizable to states without required ACS-verification laws.
Both say that the next steps in their research could focus on the outcomes of specific injury patterns or expanding their approach to study national trauma records.
Overall, Robinson says it’s crucial that pediatric and adult centers maintain an open line of communication for opportunities to enhance patient care.
"It’s important to talk about these issues between institutions,” he says. "For example, locally, if we have an adolescent that has post-traumatic stress, they may need to go to Cincinnati Children’s for their services. Cincinnati Children’s may also have a patient who needs some of the social work service we have at UC Medical Center. We need to be able to facilitate that. We don’t know the differences in the nuances of care, and that’s an exciting thing for us to explore.”
Their results, "Teen trauma without the drama: Outcomes of adolescents treated at Ohio adult versus pediatric trauma centers,” are published in the current issue of the Journal of Trauma and Acute Care Surgery.
Co-authors include: Timothy Pritts, MD, PhD, Richard Falcone, MD, MPH, and Dennis Hanseman, PhD.