Trauma Center Type and Outcomes After Pediatric Blunt Pancreatic Injury: A National Trauma Data Bank Analysis.

INTRODUCTION

The management of blunt pancreatic trauma in pediatric patients has evolved with the establishment of designated pediatric trauma centers. Given that pancreatic injuries frequently occur alongside other major injuries, studies specifically assessing outcomes remain limited. We compared outcomes for children with blunt pancreatic injury treated at pediatric versus nonpediatric trauma centers.

METHODS

Using the National Trauma Data Bank (2017-2023), we identified trauma patients aged ≤18 y with blunt pancreatic injury. Patients transferred out and those with severe nonabdominal injuries (AIS ≥3) were excluded. Outcomes included pancreas repair or resection, pancreatic duct procedures, hemorrhage control laparotomy, blood product transfusion, computed tomography (CT) utilization, in-hospital complications, discharge home, and hospital length of stay. Data were analyzed using multivariable regression and severity-adjusted models to evaluate clinical outcomes in children with blunt pancreatic injury.

RESULTS

Among 1387 children, 802 (58%) were treated at pediatric trauma centers. After adjustment, treatment at pediatric trauma centers was associated with lower odds of pancreas repair/resection (adjusted odds ratio [aOR] 0.60), lower CT abdomen/pelvis utilization (aOR 0.68), fewer in-hospital complications (aOR 0.59), and a higher likelihood of discharge home (aOR 3.97). Hospital length of stay was also shorter among children treated at pediatric trauma centers. Pancreatic duct procedures did not differ by center type. In severity-stratified analyses, these associations were most apparent in lower-grade injuries, where pediatric trauma centers were associated with lower odds of operative intervention, complications, transfusion, hemorrhage control laparotomy, and CT utilization. In the restricted cohort excluding hollow viscus or mesenteric injury, the main findings were preserved.

CONCLUSIONS

In pediatric blunt pancreatic injury, treatment at pediatric trauma centers was associated with a more favorable pattern of short-term outcomes and resource utilization. The observed associations may support early pediatric trauma center involvement for selected children with suspected blunt pancreatic injury.