Access to pediatric trauma centres in Canada: a population-based retrospective cohort study
Alexandra Lapierre1, Carmel Awlise1, Gabrielle Freire1
1Department of Social and Preventive Medicine (Lapierre, Awlise, Moore), and Research Center CHU de Québec (Lapierre, Berube, Beaulieu, Berthelot, Moore), Université Laval, Québec, Que.; Division of Emergency Medicine (Freire), Department of Pediatrics, Faculty of Medicine, University of Toronto; Child Health Evaluative Sciences Program (Freire), Peter Gilgan Institute for Research and Learning, the Hospital for Sick Children, Toronto, Ont.; Department of Surgery, Medicine and Community Health Sciences (Yanchar), University of Calgary, Calgary, Alta.; Department of Pediatrics (Zemek), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Department of Pediatric Surgery (Beaudin), CHU Sainte-Justine, Université de Montréal, Montréal, Que.; Department of Pediatrics, Emergency Medicine, and Community Health Sciences (Stang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Weiss, Beaulieu, Berthelot), Université Laval, Québec, Que.; Division of Orthopaedic Surgery (Carsen), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Emergency Medicine (Gagnon), McGill University Health Centre, Montreal Children's Hospital; School of Physical and Occupational Therapy (Gagnon), Faculty of Medicine and Health Sciences, McGill University; Montreal Children's Hospital (Burstein), Division of Pediatric Emergency Medicine, McGill University Health Centre; Department of Biostatistics, Epidemiology and Occupational Health (Burstein), McGill University, Montréal, Que.; Faculty of Nursing (Berube), Université Laval, Québec, Que.; Department of Critical Care Medicine (Stelfox), University of Calgary, Calgary, Alta.; Faculty of Medicine and Dentistry (Stelfox), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Beno), Hospital for Sick Children, University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Labrosse), Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Que.; George & Fay Yee Centre for Health Care Innovation (Klassen), Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Man.; Division of General Surgery (Haas), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care (Tillmann), University of Toronto; Division of Respirology and Critical Care Medicine (Tillmann), Department of Medicine, University Health Network; Tory Trauma Program (Tillmann), Sunnybrook Health Sciences Centre, Toronto, Ont.; Trauma Program (Priestap), London Health Sciences Centre; Department of Surgery (Merritt), Western University, London, Ont.
Background:
Children with major trauma have better outcomes when treated in pediatric trauma centres, but population-based data on access to these centres in Canada are lacking. We aimed to estimate the proportion of children with major trauma who accessed a pediatric trauma centre in Canada (through direct transport or transfer) and compare access across provinces.
Methods:
We conducted a population-based cohort study of children (aged < 16 yr) who were admitted to hospital after a major trauma (Injury Severity Score > 12) in 9 Canadian provinces (excluding Quebec) from 2016 to 2021. We estimated the adjusted incidence of access to a pediatric trauma centre across provinces using robust Poisson regression and examined the effect of age and injury severity in subgroup analyses.
Results:
Of 3007 children with major trauma, 2335 (77.6%) were directly transported (n = 879, 29.2%) or transferred (n = 1456, 48.4%) to a pediatric trauma centre. Crude access to pediatric trauma centres was higher for younger children (80.9% among those aged 0 to 5 yr, 81.7% among those aged 6 to 12 yr, 69.9% among those aged 13 to 15 yr) and those with critical injuries (88.8%). Adjusted pediatric trauma centre access was lower in British Columbia (relative risk [RR] 0.68, 95% confidence interval [CI] 0.63 to 0.74), the Atlantic provinces (RR 0.80, 95% CI 0.73 to 0.88), and Saskatchewan (RR 0.77, 95% CI 0.69 to 0.86) than Ontario, but was higher in Alberta (RR 1.06, 95% CI 1.02 to 1.10) and Manitoba (RR 1.14, 95% CI 1.09 to 1.19). Interprovincial differences were present across all subgroups (p < 0.0001).
Interpretation:
Across 9 Canadian provinces, 1 in 4 children with major trauma did not receive care in a pediatric trauma centre. These results suggest the opportunity for improvement in Canadian trauma systems to ensure that all children receive optimal injury care.
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