Management of major injury in the adolescent population is often perceived as a conundrum. On the one hand, they have the physical size and physiology of young adults. Indeed, even the mechanisms of trauma may be considered more along adult lines, especially the most common mechanism of motor vehicle crashes, where they can be positioned as either a passenger or a driver. On the other hand, they have the mental thinking and psyche closer to that of a teenager. As such, adolescents sustaining major injury are often managed in adult-based trauma centers where the presence of expertise linked to experience based on larger case numbers is felt to confer better outcomes, especially with regards to resuscitation and interventional management.
Contrary to this is evidence suggesting better outcomes when injured children are managed in pediatric centers related to lesser risk of surgical intervention in the case of solid organ injuries, more judicious use of computed tomography to limit exposure to ionizing radiation, lower threshold for neurosurgical intervention in the case of traumatic brain injury, stronger family and patient-centered care reflecting cognizance of risk for development of post-traumatic stress disorders and commitment to ongoing follow-up, especially relating to psychoeducational needs of the adolescent.
Many recent studies have investigated variations in outcomes for adolescents treated at pediatric versus adult centers. However, these outcomes generally focus on mortality, which, being a relatively uncommon outcome, may not be the best one to use.
Research Question: What, if any, are the differences in outcomes between adolescents sustaining an intraabdominal injury, TBI or femur fracture at a pediatric versus an adult trauma center?