Abstract
IMPORTANCE: Care in a pediatric (vs adult) trauma center improves outcomes for injured children aged 0 to 12 years, but whether pediatric care benefits injured adolescents is unclear. OBJECTIVE: To evaluate the association of pediatric vs adult trauma center care with mortality among severely injured adolescents. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted between April 1, 2012, and March 31, 2020, among adolescents aged 12 to 16 years who were admitted to level I or level II adult trauma centers or a level I pediatric trauma center in British Columbia, Canada. Analysis was conducted between January and September 2024. EXPOSURE: Admission to a level I pediatric trauma center or level I or level II adult trauma center. MAIN OUTCOMES AND MEASURES: The primary outcome was hospital mortality for the index trauma incident. Inverse probability of treatment weighting was used to estimate the association of admission to a pediatric trauma center with mortality. RESULTS: A total of 416 patients aged 12 to 16 years (median [IQR] age, 15 [13-16] years; 308 male [74.0%]) were admitted to a level I or level II trauma center with severe injury (201 [48.6%] at a pediatric trauma center; 83 [20.0%] at a level I adult trauma center; and 132 [31.7%] at a level II adult trauma center). Patients admitted to the pediatric trauma center (vs level I or level II adult centers) had lower median (IQR) age (14 [13-15] years vs 15 [14-16] years), higher median (IQR) Injury Severity Score (16 [9-21] vs 13 [9-18]) and fewer penetrating injuries (10 injuries [5.0%] vs 28 injuries [13.0%]). Hospital mortality was 7.0% (14 of 201 patients) among patients admitted to the pediatric center vs 4.2% (9 of 215 patients) among those admitted to an adult trauma center. There was no statistically significant difference in hospital mortality between patients admitted to pediatric vs adult trauma centers (adjusted odds ratio, 2.61; 95% CI, 0.88-7.69; P = .08). CONCLUSIONS AND RELEVANCE: In this cohort study of severely injured adolescents, pediatric trauma center admission was not associated with improved hospital mortality. These findings suggest that severely injured adolescents aged 12 to 16 years may be safely treated at either adult or pediatric trauma centers.