Infant and toddler trauma patients have similar associated risk of complications and mortality at pediatric-only versus combined pediatric-adult trauma centers

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BACKGROUND: Previous research has demonstrated that pediatric-onlyhospitals (POHs) and combined pediatric-adult trauma centers (CPACs) have comparable outcomes in generalized pediatric trauma populations. However, infants and toddlers have distinct injuries and physiology that may be infrequently seen at CPACs. This study compared pediatric trauma patients (PTPs) ≤2 years old treated at POHs versus CPACs, hypothesizing similar associated risk of mortality and in-hospital complications between hospital types. METHODS: The 2017 to 2023 TQIP database was queried for PTPs ≤2 years old. Patients were grouped by treatment at POHs or CPACs. Hypotension was defined as systolic blood pressure <70 mm Hg, tachypnea as respiratory rate >40 breaths per minute, and tachycardia as heart rate >190 beats per minute (bpm) for PTPs ≤1 year old and >140 bpm for PTPs 2 years old. Bivariate analyses and multivariable logistic regression controlling for age, injury severity score (ISS), and vitals on arrival were performed. RESULTS: Of 39,373 PTPs ≤2 years old, 26,412 (67.1%) were treated at POHs and 12,961 (32.9%) at CPACs. Demographics, ISS (4 vs. 4), and rates of emergent operation (12.1% vs. 12.5%) were similar between cohorts (all p>0.05). On arrival, POH patients were less often hypotensive (0.6% vs. 0.9%, p=0.002) and tachycardic (≤1 y old: 1.4% vs. 1.7%, p=0.007; 2 y old: 27.9% vs. 32.9%, p<0.001), but more commonly tachypneic (3.8% vs. 2.4%, p<0.001). The CPAC cohort had increased complications (1.3% vs. 1.0%, p=0.03); however, this was not significant after multivariable analysis (OR 0.87, CI: 0.71-1.08, p=0.21). Mortality rate (1.3% vs. 1.6%, p=0.07) and associated risk (OR 1.08, CI: 0.86-1.37, p=0.51) were also similar between groups. CONCLUSIONS: This seven-year national analysis demonstrated that in PTPs ≤2 years old, the associated risks of in-hospital mortality and complications were similar between POHs and CPACs. These findings reinforce that trauma verification is maintaining similar outcomes across both hospital types, even among infants and toddlers. STUDY TYPE: Retrospective database. LEVEL OF EVIDENCE: Therapeutic/care management; Level IV.

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