Children who survived car wrecks were more likely to suffer complications, and teens were more likely to die and undergo surgeries, if taken to adult hospital trauma centers than to pediatric centers, said a recent study by prominent Minnesota physicians.

Even after adjusting for variations in the severity of injuries, children taken to adult centers were twice as likely to suffer complications such as pneumonia. Patients ages 15 to 17 were twice as likely to die in adult centers than pediatric centers, and five times more likely to undergo laparotomies to explore or repair abdominal injuries.

"I didn't expect to see this much difference," said Dr. Anupam Kharbanda, chief of critical care at Children's Hospitals and Clinics of Minnesota. His study compared outcomes from 2009 to 2012 at Level 1-designated trauma centers across the U.S.

What to do about the findings, published in the Journal of Pediatric Surgery, is a tough question.

The standard in the Twin Cities is to get car wreck victims to trauma centers within 20 minutes, said Dr. Nathaniel Kreykes, a Children's trauma physician and study co-author. An ambulance generally shouldn't bypass an adult ER if the transport time would exceed that threshold.

Yet the authors hope their results alert leaders of adult trauma centers to techniques that could eliminate harmful variations in their care of children, Kharbanda said. "Best practices can be shared across these centers."

Hennepin County Medical Center in Minneapolis, North Memorial Medical Center in Robbinsdale and Regions Hospital in St. Paul have Level 1 adult trauma centers, meaning they are the most equipped to handle severe injuries. Children's in Minneapolis is the only stand-alone Level 1 pediatric center in the Twin Cities, though HCMC and Regions also have Level 1 pediatric designations.

The study showed poorer outcomes at hospitals nationally that had both adult and pediatric trauma credentials, though the disparities were not as severe as those at adult trauma hospitals. Outcomes remained poorer for car wreck victims aged 15 to 17 — suggesting that their physiology and medical needs still demand a pediatric approach, Kreykes said.

Children appeared more likely to have their spleens removed at adult centers, though the numbers were too small to be statistically significant. Spleen removals are common for trauma victims, because the organ is susceptible to rupture and bleeding, but is best avoided in children because it leaves them susceptible to infections.

"Pediatric surgeons are more comfortable just watching the kids for a little bit and seeing how it plays out," Kreykes said, "rather than taking them straight to the OR and maybe taking their spleens right out."