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Pediatric Trauma Center Utilization for Children Transported by Emergency Medical Services
Kendall J Donohue1, Lois K Lee2, Michael Monuteaux2
1Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Insights
Fewer than half of injured children meeting trauma center criteria were transported to pediatric trauma centers (PTCs), even with geographic access. This highlights a need for interventions to improve appropriate pediatric trauma care and readiness at non-PTCs.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Pediatric Critical Care
Background:
- Pediatric trauma is a major cause of death and disability in the US.
- Care at pediatric trauma centers (PTCs) improves outcomes for injured children.
- National transport patterns to PTCs for eligible children are not well understood.
Purpose of the Study:
- To evaluate emergency medical services (EMS) transport patterns for injured children meeting American College of Surgeons (ACS) trauma center criteria.
- To identify factors influencing transport to a PTC for these children.
Main Methods:
- Retrospective cohort study using the 2019-2022 National EMS Information System (NEMSIS) database.
- Included children (<16 years) meeting ACS field triage criteria.
- Assessed geographic access (60-minute ground transport) using GIS data and linked to transport outcomes via multivariable logistic regression.
Main Results:
- Of 97,985 children meeting trauma criteria, 56% had access to a PTC, but only 40.6% were transported there.
- Males and firearm injury patients were more likely to reach a PTC.
- Adolescents and rural/suburban patients were less likely to be transported to a PTC.
Conclusions:
- Less than half of eligible children with PTC access were transported to one, indicating suboptimal care.
- Interventions are crucial to increase appropriate PTC transport for pediatric trauma patients.
- Enhancing pediatric readiness at non-PTCs is also necessary to optimize care for injured children.
Objectives:
Pediatric trauma remains a leading cause of morbidity and mortality in the United States, and care at pediatric trauma centers (PTCs) is associated with improved outcomes. However, national patterns of emergency medical services (EMS) transport to PTCs for injured children meeting trauma center criteria are not well described. We sought to evaluate EMS transport patterns among injured children meeting American College of Surgeons (ACS) trauma center criteria and to identify factors associated with transport to a PTC.
Methods:
We conducted a retrospective cohort study using the National EMS Information System (NEMSIS) public-release database from 2019 to 2022. We included patients younger than 16 years who were transported by EMS for injury and met ACS trauma center field triage criteria. Patient-level EMS data were linked with geographic information system (GIS) road network analyses of trauma center locations to assess geographic access to pediatric and general trauma centers. Geographic access was defined as being within a 60-minute ground transport interval to a trauma center. The primary outcome was EMS transport to a designated PTC among children meeting trauma criteria and with geographic access to a PTC. Secondary measures included patient demographics, injury characteristics, urbanicity, region, and EMS scene and transport intervals. Multivariable logistic regression was used to identify factors independently associated with transport to a PTC.
Results:
Of 793,459 injured children transported by EMS, 97,985 (12.3%) met trauma center criteria. Among those with access to a PTC (n = 54,923, 56%), only 40.6% were transported to one. Males and children with firearm injuries were more likely to reach a PTC, whereas adolescents, suburban, or rural patients were less likely. Median transport interval was 20 min for PTC transports versus 15 min for others.
Conclusions:
Despite meeting field triage criteria and having geographic access, less than half of injured children meeting trauma center criteria were transported to PTCs. Interventions to increase appropriate transport to PTCs and enhance pediatric readiness at non-PTCs are needed to optimize trauma care for children.
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