Injury is the leading cause of death and disability for children, so timely access to a pediatric trauma center is critical for effective pediatric trauma care.
But research published by medical student and lead author Kendall Burdick in the Annals of Emergency Medicine showed significant disparities in access to pediatric trauma centers in the United States based on geography, race and ethnicity—which leaves some children at risk for poor trauma outcomes.
This study builds on a similar analysis performed by Nance et al in 2009, but also explores differences in access by race and ethnicity which had not been previously reported in the literature. Burdick, who is in the PURCH track at UMass Chan Medical School - Baystate, conducted all the geographic and demographic analyses using current (2020) pediatric trauma center data and geographic information systems to provide a more accurate analysis of geographic access by ground and air transport.
Access has Improved, But 15 Million Children Can't Reach a Pediatric Trauma Center in 60 Minutes
In 2020, there were 157 pediatric trauma centers (Level 1 - 3) in 42 U.S. states serving the pediatric population of 61,310,426 children younger than 15 years.
Analysis showed that 55% of the total U.S. pediatric population could reach a pediatric trauma center within 60 minutes by ground transport and 74% had access within 60 minutes by air transport.
While this is an increase in timely access of 8.1% by ground and 2% by air in the 13 years since Nance et al's findings—more than 15 million children can not get to a pediatric trauma within 60 minutes by air, and close to 30 million do not have timely access by ground.
Western U.S., Alaska and Hawaii have Notable Coverage Gaps
Pediatric trauma centers are frequently located in urban areas—83.6% of children living in urban census block groups had access compared to only 48.2% of children living in rural census block groups.
Asian, Black, and Hispanic children had greater access to pediatric trauma centers than American Indian/Alaskan Native, Pacific Islander/Hawaiian, and White children—with these racial and ethnic disparities reflecting pediatric trauma centers’ access by urbanicity.
This study highlights specific areas and populations needing improved resources for pediatric trauma care. Notable coverage gaps exist in the western U.S., Alaska, and Hawaii, which are areas with the lowest pediatric population density.
The authors recommend that geographic access—not just patient volume—also be considered when establishing and maintaining pediatric trauma centers.
Burdick has been conducting the study with a one-year, $5,000 Medical Student Research Grant from the Emergency Medicine Foundation and the Society for Academic Emergency Medicine with guidance from Michael Hirsh, MD, professor of surgery and pediatrics at UMass Chan Medical School, and Eric Fleegler, MD, MPH, assistant professor of pediatrics and emergency medicine at Harvard Medical School.
She has presented the study's findings to several regional and national conferences.
Racial and Ethnic Disparities in Access to Pediatric Trauma Centers in the United States: A Geographic Information Systems Analysis, Annals of Emergency Medicine, October 31, 2022 https://doi.org/10.1016/j.annemergmed.2022.08.454