Background: Access to pediatric trauma care is highly variable across the United States (US). The purpose of this study was to measure the association between pediatric trauma center (TC) care and motor vehicle crash (MVC) mortality in children (<15 years) at the US county level over 5 years (2014-2018).
Methods: The exposure was defined as the highest level of pediatric trauma care present within each county: 1) pediatric TC, 2) adult level 1/2, 3) adult level 3, or 4) no TC. Pediatric deaths due to passenger vehicle crashes on public roads were identified from the NHTSA Fatality Analysis Reporting System. Hierarchical negative binomial modelling measured the relationship between highest level of pediatric trauma care and pediatric MVC mortality within counties. Adjusted analyses accounted for population age and sex, emergency medical service response times, helicopter ambulance availability, state traffic safety laws, and measures of rurality.
Results: During the study period 3,067 children died in fatal crashes. We identified 188 pediatric TCs in 141 counties. Significant disparities in access to pediatric trauma care was observed. Specifically, 99% of pediatric trauma centers were situated in population-dense urban counties, while 28% of children lived in counties no trauma center. After risk-adjustment, counties with pediatric TCs had significantly lower rates of pediatric MVC death that those with no TC: 0.7 vs. 3.2 deaths/100,000 child-years; MRR, 0.58; 95%CI, 0.39-0.86. In counties where pediatric TCs were absent, adult level 1/2 TCs were associated with comparable risk reduction.
Conclusions: The presence of pediatric TCs was associated with lower rates of MVC death in children. Adult level 1/2 TCs appear to offer comparable risk reduction. Where population differences in pediatric trauma mortality are observed, addressing disparities in county-level access to pediatric trauma care may serve as a viable target for system-level improvement.
DOI: 10.1097/TA.0000000000003110
