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State-level geographic variation in prompt access to care for children after motor vehicle crashes
Lindsey L Wolf1, Ritam Chowdhury2, Jefferson Tweed3
1Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Insights
Access to emergency care after fatal motor vehicle crashes varies significantly for children across US states. Prompt transport is crucial for pediatric trauma outcomes and requires state-level planning.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Public Health Policy
Background:
- Motor vehicle crashes (MVCs) are a leading cause of death in children.
- Significant state-level disparities exist in pediatric trauma resources and outcomes.
- Prompt access to medical care is critical for children involved in MVCs.
Purpose of the Study:
- To examine state-level variations in timely access to care for children injured in fatal MVCs.
- To identify predictors of delayed hospital transport for pediatric trauma patients.
Main Methods:
- Analysis of the 2010-2014 Fatality Analysis Reporting System (FARS) data.
- Inclusion of children (<15 years) requiring medical transport from fatal MVC scenes.
- Multivariable logistic regression to assess transport time (>1 hour) adjusted for injury severity, transport mode, and road type.
Main Results:
- Over 10,000 children required medical transport from fatal MVCs; median transport time was 1 hour.
- State-level variation in transport time >1 hour ranged from 0% to 69% (New Mexico).
- Children with no apparent injuries and crashes on rural roads were more likely to experience delayed transport.
Conclusions:
- Substantial state-level variability exists in transport times for children after fatal MVCs.
- Findings highlight the need for state-specific pediatric trauma response planning.
- Addressing disparities in access to care can improve outcomes for pediatric trauma patients.
Background:
Motor vehicle crashes (MVCs) are a principal cause of death in children; fatal MVCs and pediatric trauma resources vary by state. We sought to examine state-level variability in and predictors of prompt access to care for children in MVCs.
Materials And Methods:
Using the 2010-2014 Fatality Analysis Reporting System, we identified passengers aged <15 y involved in fatal MVCs (crashes on US public roads with ≥1 death, adult or pediatric, within 30 d). We included children requiring transport for medical care from the crash scene with documented time of hospital arrival. Our primary outcome was transport time to first hospital, defined as >1 or ≤1 h. We used multivariable logistic regression to establish state-level variability in the percentage of children with transport time >1 h, adjusting for injury severity (no injury, possible injury, suspected minor injury, suspected severe injury, fatal injury, and unknown severity), mode of transport (emergency medical services [EMS] air, EMS ground, and non-EMS), and rural roads.
Results:
We identified 18,116 children involved in fatal MVCs from 2010 to 2014; 10,407 (57%) required transport for medical care. Median transport time was 1 h (interquartile range: [1, 1]; range: [0, 23]). The percent of children with transport time >1 h varied significantly by state, from 0% in several states to 69% in New Mexico. Children with no injuries identified at the scene and crashes on rural roads were more likely to have transport times >1 h.
Conclusions:
Transport times for children after fatal MVCs varied substantially across states. These results may inform state-level pediatric trauma response planning.
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