Big Children or Little Adults? A Statewide Analysis of Adolescent Isolated Severe Traumatic Brain Injury Outcomes at Pediatric versus Adult Trauma Centers.

BACKGROUND: The appropriate managing center for adolescent trauma patients is debated. We sought to determine whether outcome differences existed for adolescent severe traumatic brain injury (sTBI) patients treated at pediatric versus adult trauma centers. We hypothesized that no difference in mortality, functional status at discharge (FSD) or overall complication rate would be observed between center types. METHODS: All adolescent trauma patients (aged 15-17 years) presenting with isolated sTBI (head Abbreviated Injury Scale [AIS] score ≥3; all other AIS body region scores ≤2) to accredited level I-II trauma centers in Pennsylvania from 2003-2015 were extracted from the Pennsylvania Trauma Outcome Study database. Dead on arrival, transfer, and penetrating trauma patients were excluded from analysis. Adult trauma centers were defined as non-PED (n=24), while standalone pediatric hospitals and adult centers with pediatric affiliation were considered PED (n=9). Multilevel mixed effects logistic regression models and a generalized linear mixed models assessed the adjusted impact of center type on mortality, overall complications, and FSD. Significance was defined as pRESULTS: A total of 1,109 isolated sTBI patients aged 15-17 presented over the 13-year study period (non-PED: 685; PED: 424). In adjusted analysis controlling for age, shock index, head AIS, Glasgow Coma Scale (GCS) motor, trauma center level of managing facility, case volume of managing facility, and injury year, no significant difference in mortality (AOR: 0.82, 95% CI 0.23-2.86; p=0.754), FSD (Coeff.: -0.85, 95% CI -2.03 to 0.28 p=0.136), or total complication rate (AOR: 1.21, 95% CI 0.43-3.39; p=0.714) was observed between center types. CONCLUSION: Although the optimal treatment facility for adolescent patients is frequently debated, patients aged 15-17 presenting with isolated sTBI may experience similar outcomes when managed at pediatric and adult trauma centers. KEY WORDS: Adolescent; traumatic brain injury; mortality; pediatric trauma center; adult trauma center LEVEL OF EVIDENCE: Level III, Epidemiologic study. Language: en