Lit Matters 1: Where should we send adolescent trauma patients?

Severely injured adolescents do not appear to have a survival advantage at pediatric trauma centers over adult trauma centers. For teen trauma triage, the practical answer is to send 12- to 16-year-old patients to the closest appropriate trauma center rather than defaulting to pediatric transfer.

Adolescent Trauma Center Triage

• Teen physiology transition: By adolescence, injury patterns and physiology start to resemble young adults, which helps explain why adult trauma systems can perform comparably well in this age group.
• Closest appropriate center: For severely injured teens, the key disposition principle is nearest appropriate trauma care, whether that destination is a pediatric center or an adult trauma center.
• Study age window: The most relevant data here focus on patients aged 12 to 16 years with severe injury, narrowing the usual gray zone where pediatric-versus-adult transfer decisions often vary.
• Mortality signal: Hospital mortality was 7% at the pediatric trauma center versus 4.2% at adult trauma centers, with no statistically clear survival benefit for pediatric admission.
• Hospital-free days outcome: Ninety-day hospital-free days were similar between pediatric and adult trauma centers, suggesting comparable short-term recovery at the systems level. We get into the triage implications in the episode.
• Important missing factor: These outcome data do not capture psychosocial advantages that pediatric centers may offer, an important caveat when the trauma destination is otherwise clinically equivalent.