Rural Gaps Persist in Pediatric Trauma Care Access

TOPLINE: 

Access to pediatric trauma centers varied geographically, with children in rural areas facing significant challenges in obtaining timely trauma care. 

METHODOLOGY:

• This descriptive cross-sectional study compiled information on trauma centers from national organizational lists, state government websites, and online searches to create a comprehensive database.
• The analysis included 148 pediatric and 1075 high-level adult trauma centers, with population density estimated using 2020 US census data.
• Geospatial analysis assessed pediatric patient access to trauma centers via ground or air ambulance within 60 minutes.
• Pediatric-ready centers were defined as high-level pediatric trauma centers or high-level adult trauma centers with a pediatric readiness score ≥ 93.

TAKEAWAY:

• Of the 1075 high-level adult trauma centers analyzed, 273 centers (25%) met the pediatric readiness criteria.
• Among 74,090,665 children, 65% had access to a pediatric trauma center within 60 minutes by ground or air ambulance, 73% had access to a pediatric-ready trauma center, and 92% had access to any high-level trauma center.
• Children treated in emergency departments with the highest pediatric readiness score (93-100) had 26% lower adjusted observed-to-expected mortality than children treated at centers with low pediatric readiness scores (1.02 vs 1.28; P < .01).

IN PRACTICE:

“This cross-sectional study found that access to pediatric trauma center care continues to be limited in the United States,” the authors wrote. “Access to pediatric trauma centers has not changed substantially over the past 15 years, but efforts to improve pediatric readiness at adult trauma centers have improved access to high-quality initial resuscitative care in the ED for more than 5.5 million children nationally.”

SOURCE:

The study was led by Caroline Melhado, MD, MS, University of California, San Francisco. It was published online on February 3, 2025, in JAMA Pediatrics.

LIMITATIONS: 

Limitations included the undercounting of migratory individuals and those without legal residency in the United States in census data. Additionally, the lack of a national trauma center database may have led to an underestimation of trauma care access. Lastly, access to pediatric-ready centers may have been underestimated by assuming adult centers with missing weighted pediatric readiness scores were not in the highest readiness quartile.

DISCLOSURES:

This study was supported by US Department of Health and Human Services. Two authors reported receiving grant funding and consulting fees from external sources not related to this work. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.