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Michael L. Nance, MD; Brendan G. Carr, MD, MA, MS; Charles C. Branas, PhD

Arch Pediatr Adolesc Med. 2009;163(6):512-518.

Objectives  To catalog trauma center resources and estimate access to age-specific trauma care for children younger than 15 years in the United States.

Design  Cross-sectional study collating information from national, state, and local trauma systems authorities to create a catalog of verified pediatric trauma centers (PTCs) and self-designated "candidate" trauma centers. Access-to-care calculations were estimated using all US block groups and prior validated methods.

Setting  United States.

Patients  Children in the US younger than 15 years.

Main Outcome Measures  The PTC statuses of hospitals in the United States. Percentages of pediatric populations (by state and population density) having access (by ground or air) within 60 minutes to a PTC.

Results  A total of 170 verified PTCs were identified in 41 states (including the District of Columbia). An estimated 71.5% of pediatric patients were within 60 minutes of a verified PTC by air or ground transport, 43% if ground transportation only was considered. An estimated 17.4 million children did not have access to a PTC within 60 minutes. Access ranged from 22.9% of the population in the most rural areas of the United States to 93.5% in the most urban. The addition of 24 candidate centers increased coverage to 77.4% of the pediatric population being within 60 minutes of a PTC.

Conclusions  Current pediatric trauma resources vary greatly by state and population density, with many children, particularly in rural areas, underserved. A thorough standardized catalog of verified PTCs is necessary to accurately assess pediatric trauma needs now and to optimize future trauma system planning for children.

Author Affiliations: Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Nance); Departments of Emergency Medicine (Dr Carr) and Biostatistics and Epidemiology (Drs Carr and Branas), University of Pennsylvania School of Medicine, Philadelphia.

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