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Injured adolescents—should they be treated as big kids or little adults?
  1. Caroline Leech1,
  2. Rachel Jenner2,3
  1. 1Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
  2. 2Paediatric Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
  3. 3Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, The University of Manchester, Manchester, UK
  1. Correspondence to Dr Caroline Leech, Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; caroline.leech{at}

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Adolescence, the period of transition between childhood and adulthood, has traditionally been considered ages 10–19 years according to the WHO. However, acknowledging that ongoing physical and psychological development occurs up to mid-20s and that young people now have delayed partnering, parenting and economic independence, many consider that a more suitable modern definition of adolescence includes the ages 10–24 years.

In England in 2012, trauma networks were established with the designation of 11 adult, 5 paediatric and 11 mixed (adult and paediatric) major trauma centres (MTCs). Many of the adult MTCs function as paediatric trauma units, whereas others only provide care for adults. Within these networks, severely injured patients aged under 16 years are triaged to a children’s MTC and those 16 years or older are triaged to an adult MTC. Operationally, it can be difficult to accurately estimate the age of unconscious adolescents or a paediatric patient may be too unstable for a transfer to a designated children’s hospital, resulting in an adolescent being triaged to the ‘wrong’ trauma centre for the cut-off age of 16 years. In addition, in multiple casualty incidents, the priority of keeping families together may result in children presenting to a mixed or adult MTC.

In their EMJ study, Evans et al1 present data from the Trauma Audit Research Network comparing the outcomes of adolescent trauma patients aged 10–24.99 years who had a primary transfer to a MTC from 2012 to 2018. Of the total 30 321 patients, 54% presented to a mixed MTC, 38% to an adult MTC and 8% to a children’s MTC. The majority of patients (66.5%) were over 18 years old; 430 patients under 16 years attended an adult MTC and only 17 patients over 16 years attended a children’s MTC.

The primary outcome was mortality within 30 days …

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  • Handling editor Ellen J Weber

  • Twitter @leechcaroline, @rmjenner

  • Contributors Both authors contributed equally to the drafting and editing of this manuscript.

  • 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 None declared.

  • 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 Commissioned; internally peer reviewed.

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