More than 17 million U.S. children live more than an hour away by ground or air transportation from a life-saving pediatric trauma center, according to a new study by researchers at The Children's Hospital of Philadelphia and the University of Pennsylvania. The creation of a national inventory of pediatric trauma centers may help to identify the locations of gaps and greatly improve access to care for U.S. children, the authors said.
The average proximity to a pediatric trauma center varies widely from state to state, with the largest gaps in the most rural areas. Hawaii, Maine, Montana, New Mexico, North Dakota and Wyoming offer almost no access to a verified pediatric trauma center in less than an hour, while virtually all children living in areas such as the District of Columbia, New Jersey, Connecticut, Maryland, Massachusetts and Rhode Island are within 60 minutes of specialized trauma care. Establishing guidelines for the basic resources necessary for designation as a pediatric trauma center and maintaining an inventory of the location of these centers may improve today's fragmented access to life-saving trauma care, the study authors said.
Studies show trauma centers provide benefit to severely injured patients of all ages, and timely access to medical care may save lives. In children ages 1 to 14, injury causes more deaths than all other causes combined. While more than 70 percent of U.S. children can be transported by either ground or air to a pediatric trauma center within an hour, vast pockets live in regions that are too far away. Past studies have shown similar gaps in the adult population living in rural areas.
"This study shows that access to pediatric trauma centers is variable and inadequate in many areas of the U.S. Timely access to the best possible care is likely to save the lives of more children," said Michael L. Nance, M.D., lead author of the study and director of the Trauma Program at Children's Hospital. "We need to set up guidelines to help hospitals understand what is required to establish a pediatric trauma center where those centers should be."
The study identified 170 pediatric trauma centers in 40 states and the District of Columbia, which equals about one center for every 358,000 children. The American College of Surgeons Committee on Trauma accredits most U.S. trauma centers. The researchers combined that organization's records with the American Trauma Society's list of adult centers designated as "pediatric capable," and the National Association of Children's Hospitals and Related Institutions' members self-classified as trauma centers.
"The lack of a single national accrediting body or uniform standards for pediatric trauma centers has been an obstacle to understanding the resources that exist for the care of our most severely injured children," said Nance, who added, "A reliable inventory of accredited pediatric trauma centers will allow for expansion of resources into areas currently underserved."
The study did not look at patient outcomes from injury as it relates to access to a center in under an hour. And, although the care delivered to children in an adult-care setting may be adequate, without reliable guidelines, it is impossible to determine if the best care is being provided to the most severely injured children.
Dr. Nance's co-authors, both from the University of Pennsylvania School of Medicine, are Brendan G. Carr, M.D., M.S., from the Departments of Emergency Medicine and Epidemiology; and Charles C. Branas, Ph.D., from the Departments of Biostatistics and Epidemiology. The study was supported in part from the Josephine J. and John M. Templeton, Jr., Endowed Chair in Pediatric Trauma.
- Nance et al. Access to Pediatric Trauma Care in the United States. Archives of Pediatrics and Adolescent Medicine, 2009; 163 (6): 512 DOI: 10.1001/archpediatrics.2009.65
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