Pediatric trauma care: An overview of pediatric trauma systems and their practices in 18 US states

Purpose: The aim of this study was to describe the state of pediatric trauma system development in the United States in 1997 and 1998 and to characterize the hospitalization patterns of injured children in states with different types of pediatric trauma systems. The authors also investigated the impact of sociodemographic, injury, and geographic characteristics on those hospitalization patterns. Methods: The authors combined statewide hospital discharge data on hospitalized trauma patients less than 15 years old with data from the American Hospital Association, the Area Resource File, the Office of Management and Budget, the states' Departments of Health, and the US Census. Besides conducting descriptive analyses, the authors evaluated the role of several parameters in determining the likelihood of treatment in trauma and nontrauma centers using multivariate multinomial logistic regression models. Results: There were 15 states with adult and pediatric trauma designation systems; 9 of them had statewide hospital discharge data available. In these 9 states, 77% of the discharges were from trauma centers with no pediatric designation. More severely injured children and children with injuries to the head, face, thorax, and abdomen were more likely to be discharged from trauma centers, although large percentages of these children were treated in nontrauma centers. Older children and children with commercial insurance were less likely to be treated at trauma centers, even when injury severity, body region injured, and other factors were accounted for. Conclusions: Even in states with trauma systems, a large proportion of severely injured children are treated in nontrauma center facilities.