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Disparities in the delivery of pediatric trauma care
Mikael Petrosyan1, Yigit S Guner, Claudia N Emami
1Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Insights
Most injured children do not receive care at pediatric trauma centers (PTC), leading to disparities. While some studies suggest PTC improve outcomes, definitive evidence for pediatric trauma care remains elusive.
Area of Science:
- Pediatric Trauma Care
- Trauma System Evaluation
- Healthcare Disparities
Background:
- Trauma is a leading cause of death and disability in children.
- Pediatric trauma centers (PTC) were established to improve outcomes for injured children.
- Existing trauma systems aim to optimize care for the injured.
Purpose of the Study:
- To determine if pediatric trauma centers (PTC) provide better care than adult trauma centers (ATC) or other hospitals.
- To assess outcomes for injured children based on treatment location.
- To identify disparities in pediatric trauma care.
Main Methods:
- Systematic review of over 60 published studies on pediatric trauma outcomes.
- Inclusion of registry analyses, single and multi-hospital experiences.
- Analysis encompassed various trauma types (abdominal, head/neck, thoracic) and functional outcomes.
Main Results:
- Most children are not treated at PTC due to limited availability and specialist shortages.
- Disparities in outcomes exist based on where children receive treatment.
- Some data suggest lower mortality and better outcomes at PTC, but findings are not definitive across all studies.
Conclusions:
- This analysis does not definitively conclude which trauma center type offers superior care for injured children.
- Identified gaps and disparities in pediatric trauma care require attention.
- Education and training initiatives can help address current care disparities.
Background:
Trauma is the leading cause of morbidity and mortality in children. During the last few decades, trauma systems have evolved to improve the care of the injured with an ultimate goal of saving lives. As a result, pediatric trauma centers (PTC) have been established to optimize outcomes for injured children. We sought to determine whether injured children treated at PTC or adult trauma centers (ATC) with added qualifications to treat injured children receive better trauma care than those treated at other hospitals or trauma centers.
Methods:
We reviewed more than 60 published studies on pediatric trauma outcomes. The studies included registry analysis: single and multihospital experience; abdominal, head and neck, and thoracic trauma; as well as functional outcomes.
Results:
The data show that most injured children are not treated at PTC due to the geographically limited distribution of such specialized care, lack of pediatric surgeons, and other specialists. These limitations create persistent disparities in outcomes for injured children depending on where they are treated. Some of the larger database analyses suggest lower mortality rate, better outcome for nonoperative treatment of blunt abdominal injuries, and improved overall functional outcome for those children treated at PTC. However, others fail to demonstrate differences for children treated at ATC or ATC with added qualifications.
Conclusion:
Although this analysis does not provide a definitive answer to the question as to which type of trauma center provides better care for injured pediatric patients, it identifies current gaps and disparities in the care of injured children that can be remedied through education and training.
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