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Variability in pediatric utilization of trauma facilities in California: 1999 to 2005
N Ewen Wang1, Olga Saynina, Kristin Kuntz-Duriseti
1Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA. Ewen@stanford.edu
Insights
Geographic and socioeconomic factors significantly impact injured children's access to trauma centers. Children living farther from trauma centers or with certain insurance types are less likely to receive specialized care.
Area of Science:
- Pediatric Trauma Care
- Health Services Research
- Public Health Policy
Background:
- State-designated trauma centers provide specialized care for injured children.
- Understanding disparities in access to trauma care is crucial for improving outcomes.
Purpose of the Study:
- To identify geographic, system, and socioeconomic factors influencing trauma center utilization in injured children.
- To analyze variations in care based on distance, county designation, and insurance type.
Main Methods:
- Nonconcurrent observational study using California patient discharge data (1999-2005).
- Analysis of children aged 1-14 with trauma-related diagnoses (ICD-9 codes).
- Calculation of Injury Severity Scores and logistic regression to identify predictors of trauma center use.
Main Results:
- Severe injury patients living farther from trauma centers (0-10, 11-25, 26-50, >50 miles) accessed them at decreasing rates (80.0% to 28.5%).
- Patients in counties with trauma centers had higher utilization (78.8%) than those without (39.0%).
- Health Maintenance Organization (HMO) and private non-HMO insurance patients used trauma centers less than public insurance patients (55.4% and 68.0% vs. 77.7%).
Conclusions:
- Significant variations exist in trauma center utilization for pediatric trauma patients.
- Insurance type, distance to a trauma center, and county trauma center designation are key predictors of utilization.
- Findings suggest a need to reassess referral policies to ensure equitable, high-quality trauma care for all children.
Study Objective:
We identify geographic, system, and socioeconomic differences between injured children cared for within and outside of state-designated trauma centers.
Methods:
This was a nonconcurrent observational study of a population-based sample from the California Office of Statewide Health Planning and Development Public Patient Discharge Database 1999 to 2005. Patients were 1 to 14 years of age, with International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes indicative of trauma. Injury Severity Scores were calculated from ICD-9 codes and categorized into severity categories. Outcomes were hospitalization in a trauma or nontrauma center.
Results:
Children with severe injury who resided 0 to 10, 11 to 25, 26 to 50, and more than 50 miles from a trauma center were hospitalized in these centers at rates of 80.0%, 71.2%, 51.4%, and 28.5%, respectively. Children with severe injury who were living in a county with a trauma center were hospitalized in these centers at rates of 78.8%, whereas children living in a county without a trauma center were hospitalized in trauma centers at rates of 39.0%. Children with severe injury and public, private non-health maintenance organization (HMO), and HMO insurance were hospitalized in trauma centers at rates of 77.7%, 68.0%, and 55.4%, respectively. Age, injury severity, insurance type, residence in a county with a trauma center, and proximity to a trauma center were identified as predictors of trauma center utilization by logistic regression.
Conclusion:
We demonstrate considerable variation in the utilization pattern of trauma specialty care for children with moderate and severe injuries. Children with HMO and private insurance are cared for less often in trauma centers than those with public insurance, even after adjustment for other variables. Increased distance to a trauma center, as well as lack of trauma center within a county, also decreases trauma center utilization. These results suggest that assessing trauma center utilization patterns in total populations of children may identify opportunities for improved referral policies and practices as part of a larger effort to ensure high-quality trauma care for all children in need.
