Pediatric Readiness and Trauma Center Access for Children

Abstract

ImportanceChildren initially treated in a timely fashion at trauma centers with high levels of pediatric readiness have been shown to have improved survival, but children historically have had geographically disparate access to pediatric trauma center care. Considerable effort has been invested in improving pediatric readiness nationally, including the implementation of new standards to improve emergency department pediatric readiness at all trauma centers.ObjectiveTo assess current access to US pediatric-ready trauma center care and to estimate potential improvement in access if all high-level trauma centers had optimal pediatric readiness.Design, Setting, and ParticipantsThis descriptive cross-sectional study collated trauma centers from national organizational lists, state government websites, and online searches. A geospatial analysis was performed of access by pediatric patients (aged ≤18 years) to trauma centers by ground or air ambulance within 60 minutes, stratified by trauma center type and pediatric readiness status. Population density was estimated using 2020 US census data. Weighted pediatric readiness scores (wPRS) were obtained from the 2021 National Pediatric Readiness Project assessment. The data analysis was performed between April 1 and June 30, 2023.ExposureAccess times to trauma centers.Main Outcome and MeasureThe main outcome of interest was access to a pediatric-ready trauma center, defined as a high-level pediatric trauma center (level I-II) or high-level adult trauma center (level I-III) with a wPRS of at least 93 (out of 100). Access times were calculated using previously validated methods and service network model analysis for each trauma center to census block group centroid.ResultsThe analysis included 148 pediatric and 1075 high-level adult trauma centers. A total of 273 adult centers (25%) were pediatric ready. Pediatric trauma center access within 60 minutes by ground or air ambulance was available for 65% of all 74 090 665 children; 73% of children had access to a pediatric-ready trauma center within 60 minutes, and 92% had access to any high-level trauma center within 60 minutes.ConclusionThese findings suggest that access to pediatric trauma center care is limited, even with air ambulance transport. Ensuring pediatric readiness at all high-level adult trauma centers may substantially improve access to early high-quality initial resuscitative trauma care for children.