E. J. Onufer1, P. M. Choi1, C. M. Courtney1, M. Wallendorf1, A. M. Vogel1, M. S. Keller1 1Washington University,General Surgery,St. Louis, MO, USA
Introduction: Controversy exists regarding optimal trauma center qualifications for management of children injured by firearms. We sought to determine if outcome differences exist for these patients if managed at adult vs pediatric, American College of Surgeons (ACS)-verified Level-1 trauma centers.
Methods: We conducted a retrospective review of the 2013-2014 National Trauma Databank. We included all patients aged < 18 years who were injured by a firearm and admitted to an ACS-verified Level-1 trauma center. Patients who died on arrival to the Emergency Unit or were transferred were excluded. Centers were classified as freestanding Pediatric Trauma Centers (PTC), Adult Trauma Center with Pediatric qualifications (ATC/PTC), and Adult Trauma Centers (ATC). Patients were grouped to ≤ 14 years and 15-17 years of age.
Results: 1866 children met inclusion criteria. Younger patients were treated more commonly at a PTC(Table1). Across all centers, both age groups demonstrated demographic and injury severity differences. After controlling for these differences, children ≤14 years admitted to an ATC/PTC had a higher adjusted odds ratio of blood transfusions (OR 2.77; 95%CI 1.13-6.8); and laparotomies (OR 3.57; 95%CI 1.14-11.24) compared those admitted to a PTC. Children 15-17 years of age, managed at either an ATC (OR 8.87; 95%CI 3.14-25.05) or ATC/PTC (OR 9.38; 95%CI 3.15-27.97), also had a greater adjusted odds ratio for laparotomy than those managed at a PTC. There were no differences in mortality, complications, computed tomography, thoracotomies, length of stay (LOS), ICU LOS, or ventilator days.
Conclusion: After accounting for demographic and injury severity differences, there were no differences in outcome variables between the PTC, ATC/PTC and ATC. These data support the management of children with firearm related injuries, typically considered an “adult pattern injury”, at PTC.
