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Abstract
Objective We aimed to compare adolescent mortality rates between different types of major trauma centre (MTC or level 1; adult, children’s and mixed).
Methods Data were obtained from TARN (Trauma Audit Research Network) from English sites over a 6-year period (2012–2018), with adolescence defined as 10–24.99 years. Results are presented using descriptive statistics. Patient characteristics were compared using the Kruskal-Wallis test with Dunn’s post-hoc analysis for pairwise comparison and χ2 test for categorical variables.
Results 21 033 cases met inclusion criteria. Trauma-related 30-day crude mortality rates by MTC type were 2.5% (children’s), 4.4% (mixed) and 4.9% (adult). Logistic regression accounting for injury severity, mechanism of injury, physiological parameters and ‘hospital ID’, resulted in adjusted odds of mortality of 2.41 (95% CI 1.31 to 4.43; p=0.005) and 1.85 (95% CI 1.03 to 3.35; p=0.041) in adult and mixed MTCs, respectively when compared with children’s MTCs. In three subgroup analyses the same trend was noted. In adolescents aged 14–17.99 years old, those managed in a children’s MTC had the lowest mortality rate at 2.5%, compared with 4.9% in adult MTCs and 4.4% in mixed MTCs (no statistical difference between children’s and mixed). In cases of major trauma (Injury Severity Score >15) the adjusted odds of mortality were also greater in the mixed and adult MTC groups when compared with the children’s MTC. Median length of stay (LoS) and intensive care unit LoS were comparable for all MTC types. Patients managed in children’s MTCs were less likely to have a CT scan (46.2% vs 62.8% mixed vs 64% adult).
Conclusions Children’s MTC have lower crude and adjusted 30-day mortality rates for adolescent trauma. Further research is required in this field to identify the factors that may have influenced these findings.
- paediatrics
- paediatric injury
- paediatric emergency medicine
- trauma
- majot trauma management
Data availability statement
Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.
Statistics from Altmetric.com
Data availability statement
Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.
Footnotes
Handling editor Caroline Leech
Twitter @damian_roland, @mdlyttle
Contributors SM conceived the study. SM and OB undertook the data collection. OB performed the statistical analysis of the data. JE, HM, RB and SM interpreted the data and drafted the manuscript. All authors contributed substantially the study design and revision of the manuscript with supervision from DR, MDL and SM. All authors have approved the manuscript and agree to be accountable for the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests DR is a member of TARNLet (the Paediatric Working Group on behalf of TARN). OB is employed as a Medical Statistician for TARN.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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