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The spatial epidemiology of pediatric trauma: A statewide assessment
Allison M Ertl1, Kirsten M M Beyer, Sergey Tarima
1From the Institute for Health and Society (A.M.E., K.M.M.B., S.T., Y.Z., L.D.C.), Medical College of Wisconsin, Milwaukee, Wisconsin; and Nationwide Children's Hospital, (J.I.G.) Columbus, Ohio.
Background:
Despite significant advances in the prevention and treatment of pediatric trauma, preventable injuries continue to burden the lives of millions of children. To target prevention strategies, it is critical to identify areas with high burdens of pediatric trauma. Therefore, this study analyzed statewide data from the Ohio Trauma Registry from 2007 to 2012 to identify geographical patterns in pediatric injury.
Methods:
Data from the first hospital of care for 16,330 pediatric trauma patients younger than 16 years were analyzed using the disease mapping method adaptive spatial filtering to estimate a series of maps that display age- and sex-adjusted rates of pediatric trauma, severe trauma, and standardized mortality ratios while controlling for population size to create stable estimates throughout the study area. The locations of all trauma centers were mapped to highlight access to trauma care.
Results:
Areas with significantly higher than expected rates of severe injury were identified in nonurban areas, where children lacked timely access to a pediatric trauma center or Level I adult trauma center. Although highest standardized mortality ratios were in urban areas, nonurban areas experienced elevated mortality with rates over four times higher than expected.
Conclusion:
Areas with higher than expected age- and sex-adjusted rates of severe injury and mortality should be further explored to identify opportunities for injury prevention and appropriate access to timely care.
Level Of Evidence:
Epidemiologic study, level III.