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Pediatric trauma centers: correlation of ACS-verified trauma centers with CDC statewide pediatric mortality rates
David M Notrica1, Jeffrey Weiss, Pamela Garcia-Filion
1Level I Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona 85016, USA. Dnotrica@surgery4children.com
Insights
Verified pediatric trauma centers (PTCs) are associated with lower child injury mortality rates. States with American College of Surgeons-verified Level I PTCs showed significantly reduced mortality, highlighting the importance of these specialized centers for pediatric care.
Area of Science:
- Pediatric trauma care
- Public health
- Injury prevention
Background:
- Conflicting research exists on the impact of pediatric trauma centers (PTCs) on mortality rates.
- Previous studies often used differing methodologies, leading to varied conclusions.
Purpose of the Study:
- To assess the association between American College of Surgeons (ACS)-verified trauma centers and pediatric injury mortality rates.
- To determine if the presence and verification level of PTCs influence state-level mortality.
Main Methods:
- A population-based study analyzing 2008 state pediatric injury mortality data from the CDC.
- Regression analysis was used to compare mortality rates with the availability of verified PTCs (vPTCs), adjusting for covariates.
- Examined the correlation between mortality and the type/number of vPTCs per pediatric population.
Main Results:
- Verified PTCs were present in 36% of states; Level I vPTCs were in 24%.
- States without vPTCs had a mean mortality rate of 20.6 per 100,000 children.
- Presence and higher verification levels of vPTCs correlated with decreased pediatric injury mortality (p=0.004).
- States with only Level I vPTCs had 37% lower mortality (12.9 per 100,000).
- Higher ratios of Level I vPTCs per population strongly correlated with lower mortality rates (p=0.003).
Conclusions:
- A significant correlation exists between the presence of ACS-verified Level I PTCs and reduced state pediatric injury mortality rates.
- The findings underscore the positive impact of verified trauma centers on child injury outcomes.
Background:
Research on the impact of pediatric trauma centers (PTCs) on mortality has been conflicting, most likely owing to differing methodologies. Using a population-based approach, we assessed whether American College of Surgeons (ACS)-verified trauma centers are associated with reduced overall state pediatric injury mortality rates.
Methods:
A population-based study of state pediatric injury mortality rates (per 100,000 children ≤ 18 years) using data for 2008 from Centers for Disease Control and Prevention-National Center for Injury Prevention and Control. The availability of verified PTCs (vPTCs) and ACS-verified adult trauma centers in each state was determined and compared with mortality rates using regression, adjusting for injury mortality covariates. Correlation of mortality with type of trauma centers available was determined. The mortality versus number of PTCs per pediatric population was also examined.
Results:
vPTCs were present in 36% of states, including 24% of states with Level I vPTCs. The mean (SD) pediatric injury mortality for the 32 states without a vPTC was 20.6 (6.6) per 100,000 children 18 years or younger. Presence and higher verification level of vPTC within a state correlated with decreasing pediatric injury mortality (p(unadjusted)= 0.005; p(adjusted) = 0.004). Mortality was 37% lower among states with only Level I vPTCs (12.9 [2.2]). Mortality was inversely correlated with the number of Level I vPTCs (p(unadjusted) = 0.006; p(adjusted) = 0.06) and lowest for states with two Level I vPTCs (11.8 [1.7]). Higher ratios of Level I vPTCs per population correlated with lower mortality rates (β = -3.53, p = 0.003).
Conclusion:
The findings highlight a correlation between state pediatric injury mortality rates and presence of ACS-verified Level I PTCs.
Level Of Evidence:
Prognostic study, level IV.
