Many US children have inadequate access to pediatric trauma care

Approximately 30 percent U.S. children live more than one hour away from a pediatric trauma center by ground or by air transportation, according to a report in the June issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. More children between ages 1 and 14 die of injuries than of all other causes combined, according to background information in the article. Trauma centers have been shown to provide a survival benefit to severely injured adult and pediatric patients. Although a comprehensive inventory of adult trauma centers is regularly updated, no similar listing of pediatric trauma centers currently exists.

Michael L. Nance, M.D., of the Children's Hospital of Philadelphia, and colleagues used information from national, state and local trauma systems authorities to create a catalog of verified pediatric trauma centers along with self-identified trauma centers. Using U.S. Census and Postal Service data, along with information about air medical services, the authors calculated access to age-specific trauma care services for American children younger than 15.

A total of 170 verified pediatric trauma centers were identified, located in 41 states (including the District of Columbia). An estimated 71.5 percent of children younger than 15 were within 60 minutes of one of the centers by ground or by air transportation, whereas 43 percent were within 60 minutes if only ground transportation was considered. The authors estimate that 17.4 million U.S. children would not have access to a pediatric trauma center within 60 minutes.

"Access ranged from 22.9 percent of the population in the most rural areas of the United States to 93.5 percent in the most urban," the authors write. Access also varied by state, ranging from more than 90 percent of children having access in 11 states to less than 25 percent having access in 12 states. "The addition of 24 candidate centers [not verified] increased coverage to 77.4 percent of the pediatric population being within 60 minutes of a pediatric trauma center."

"While this study does not directly address outcome from injury as it relates to pediatric trauma care access, it stands to reason that limited access may equate to suboptimal trauma care and a lower likelihood of survival," the authors write. "Several authors have demonstrated superior outcomes for children treated in designated pediatric trauma centers." Adult-focused trauma centers may lack pediatric-specific personnel and equipment; however, most injured children are still treated at these facilities.

"Understanding the distribution of existing pediatric trauma centers and gaps in access will allow for more thoughtful trauma systems planning," they conclude. "The creation of an inventory of pediatric trauma care centers allowed us to perform these access calculations. A hospital's capacity to provide optimal care for injured children, however, is dynamic, and our inventory captures only a fixed moment in time. To optimize pediatric trauma care planning, the development of a thorough, standardized and continuously updated catalog of pediatric trauma care resources is necessary."

Source: JAMA and Archives Journals