Variation in the management of adolescent patients with blunt abdominal solid organ injury between adult versus pediatric trauma centers: an analysis of a statewide trauma database Kazuhide Matsushima, MD, a, * Afif N. Kulaylat, MD, a Eugene J. Won, BA, a Audrey L. Stokes, BA, a Eric W. Schaefer, MS, b and Heidi L. Frankel, MD c a Division of Trauma, Acute Care and Critical Care Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania b Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania c Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, California article info Article history: Received 19 November 2012 Received in revised form 4 February 2013 Accepted 22 February 2013 Available online 16 March 2013 Keywords: Adolescent trauma Blunt abdominal solid organ injury Pediatric trauma center Adult trauma center abstract Background: Optimal management of adolescent trauma patients with blunt abdominal solid organ injury (SOI) remains controversial. The purpose of this study was to identify management differences in adolescents with SOI treated at adult trauma centers (ATC) versus pediatric trauma centers (PTC). We hypothesized that adolescents with SOI would undergo different treatment at ATC and PTC. Materials and methods: Retrospective review of the Pennsylvania Trauma Systems Foun- dation database from 2005e2010 was performed. Adolescent patients (13e18 y old) with SOI (spleen, liver, and kidney injury) were included. Patient baseline characteristics and care processes for each injury were compared between ATC and PTC. Results: A total of 1532 patients with at least one SOI were identified: 946 patients had a splenic injury, 505 had a liver injury, and 424 had a kidney injury. Spleen and liver procedures were performed more often at ATC than at PTC irrespective of injury grade (respectively, 16.1% versus 3.2%, 5.9% versus 0%; P < 0.01). Transarterial embolization for splenic injury was more frequently performed at ATC (2.8% versus 0.6%; P ¼ 0.02). After adjusting for potential confounding factors, care at PTC was significantly associated with lower odds of splenic procedure for patients with splenic injury (OR: 0.16, 95% CI: 0.08e0.36, P < 0.001). In a subgroup analysis of nontransfer patients, care at PTC remained significantly associated with lower odds of splenic procedure (OR: 0.24, 95% CI: 0.10e0.59, P ¼ 0.002) despite higher median injury severity score than ATC. Conclusions: Significant differences in the management of adolescents with SOI were identified in Pennsylvania. Operative intervention for SOI was more often performed at ATC than at PTC. Further study will be needed to address the impact of these disparities on patient outcomes. ª 2013 Elsevier Inc. All rights reserved. * Corresponding author. Division of Trauma, Acute Care and Critical Care Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, P.O. Box 850, MC H075, Hershey, PA 17036. Tel.: þ1 717 531 6066; fax: þ1 717 531 0321. E-mail address: kmatsushima@hmc.psu.edu (K. Matsushima). Available online at www.sciencedirect.com journal homepage: www.JournalofSurgicalResearch.com journal of surgical research 183 (2013) 808 e813 0022-4804/$ e see front matter ª 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2013.02.050