Nguyen Lily, Grigorian Areg, Lee Carlin, Goodman Laura F, Guner Yigit, Kuza Catherine, Swentek Lourdes, Nahmias Jeffry
From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA (Nguyen, Grigorian, Lee, Goodman, Guner, Swentek, Nahmias).
Department of Anesthesiology, Harbor-UCLA, Torrance, CA (Kuza).
J Am Coll Surg. 2025 Aug 1;241(2):232-238. doi: 10.1097/XCS.0000000000001249. Epub 2025 Jul 16.
Adult trauma centers, including combined pediatric and adult centers (CPACs), see high volumes of penetrating trauma. Few studies have compared outcomes of adolescents presenting with gunshot wounds at CPACs vs pediatric-only hospitals (POHs). This study aimed to compare injury patterns, complication, and mortality for adolescents sustaining gunshot wounds presenting to CPACs vs POHs, hypothesizing decreased associated risk of complication and mortality at CPACs.
The TQIP database from 2017 to 2021 was queried for adolescents (aged 12 to 17 years) with isolated gunshot wounds. Patients transferred or with brain injury were excluded. CPACs included centers with adult and pediatric American College of Surgeons verification, whereas POHs only had pediatric American College of Surgeons verification. Multivariable logistic regression analysis was performed to identify risk factors associated with in-hospital complications and mortality, controlling for age, injury severity score, vitals, operation, and blood transfusion.
Of 3,064 adolescents presenting with gunshot wounds, 1,512 (49.3%) presented to CPACs. When compared with POH, CPAC patients were slightly older (median 16 vs 15 years old, p < 0.001) had increased injury severity score (median 9 vs 4, p < 0.001), and injury to the spine (9.3% vs 5.7%, p < 0.001), heart (2.3% vs 0.7%, p < 0.001), lung (19.1% vs 10.6%, p < 0.001), liver (8.5% vs 4.8%, p < 0.001), and spleen (3.2% vs 1.5%, p = 0.002). CPAC adolescents also had increased rate of emergent operation (31.9% vs 23.5%, p < 0.001). However, on multivariable analysis, CPAC adolescents had a similar associated risk of in-hospital complication (odds ratio 0.91, 95% CI 0.59 to 1.41, p = 0.68) and mortality (odds ratio 0.76, 95% CI 0.40 to 1.48, p = 0.42).
Adolescent patients with gunshot wounds had similar associated risk of mortality and complication when comparing POHs with CPACs. This suggests that adolescents with gunshot wounds receive similar care at both CPACs and POHs. Additional research is warranted to corroborate these findings.
