Comparing Admission Patterns Between Combined Pediatric-Adult and Pediatric-Only Trauma Centers.

Introduction: Prior studies have demonstrated improved outcomes for admitted children at pediatric-only hospitals (POHs) (e.g. children's hospitals) versus combined pediatric-adult trauma centers (CPACs). However, there is a paucity of data regarding disparities of overall and intensive care unit (ICU) admissions between POHs and CPACs. This study compared POHs versus CPACs, hypothesizing increased overall and ICU admissions at CPACs.

Methods: A retrospective (2017-2021) analysis of the Trauma Quality Improvement Program database was performed, comparing 1-14-y-old patients treated at POHs versus CPACs. The primary outcomes were overall and ICU admissions rates. Secondary outcomes include inpatient complications and mortality. Two separate multivariable logistic regression analyses evaluated associated risk of mortality and risk of complications for those admitted, controlling for age, injury severity score, mechanism of injury, and brain injury.

Results: Of 199,414 children, 110,041 (55.2%) were treated at POHs and 89,373 (44.8%) at CPACs. Patients admitted to POHs were slightly younger (median 7 versus 8 y-old, P < 0.001) and had a decreased yet statistically different median injury severity score (POH: 4 versus CPAC: 5, P < 0.001). CPAC patients had increased overall (77.8% versus 66.2% P < 0.001) and ICU admissions (13.6% versus 6.3%, P < 0.001). POH patients had statistically decreased complications (1.2% versus 1.3%, P = 0.041) and mortality (0.7% versus 0.9%, P < 0.001). However, these findings did not persist on multivariable analysis (complications: P = 0.99; mortality: P = 0.12).

Conclusions: This national analysis demonstrated differences in admission patterns between POHs and CPACs. The higher admission rates at CPACs yet similar associated risk of complications and mortality suggest a potential opportunity for improvement efforts at these centers.