Citation

Pender T, David AP, Dodson B, Calland JF. J. Public Health (Oxford) 2019; ePub(ePub): ePub.

Affiliation

Department of Surgery-Division of Acute Care Surgery and Outcomes Research, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA.

Copyright

(Copyright © 2019, Oxford University Press)

DOI

10.1093/pubmed/fdz091

PMID

31822890

Abstract

BACKGROUND: Trauma is the leading cause of mortality in the pediatric population >1 year. Analyzing relationships between pediatric trauma-related mortality and geographic access to trauma centers (among other social covariates) elucidates the importance of cost and care effective regionalization of designated trauma facilities.

METHODS: Pediatric crude injury mortality in 49 United States served as a dependent variable and state population within 45 minutes of trauma centers acted as the independent variable in four linear regression models. Multivariate analyses were performed using previously identified demographics as covariates.

RESULTS: There is a favorable inverse relation between pediatric access to trauma centers and pediatric trauma-related mortality. Though research shows care is best at pediatric trauma centers, access to Adult Level 1 or 2 trauma centers held the most predictive power over mortality. A 4-year college degree attainment proved to be the most influential covariate, with predictive powers greater than the proximity variable.

CONCLUSIONS: Increased access to adult or pediatric trauma facilities yields improved outcomes in pediatric trauma mortality. Implementation of qualified, designated trauma centers, with respect to regionalization, has the potential to further lower pediatric mortality. Additionally, the percentage of state populations holding 4-year degrees is a stronger predictor of mortality than proximity and warrants further investigation.

© The Author(s) 2019. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Language: en

Keywords

education; geography; mortality; pediatric; trauma