L. L. Wolf1,2, R. Chowdhury1, J. Tweed3, L. Vinson3, E. Losina4, A. H. Haider1,2, F. G. Qureshi3,5 1Center For Surgery And Public Health, Brigham And Women’s Hospital,Department Of Surgery,Boston, MA, USA 2Brigham And Women’s Hospital,Division Of Trauma, Burns, And Surgical Critical Care,Boston, MA, USA 3Children’s Medical Center Of Dallas, Part Of Children’s Health,Dallas, TX, USA 4Orthopaedic And Arthritis Center For Outcomes Research, Brigham And Women’s Hospital,Department of Orthopedic Surgery,Boston, MA, USA 5University Of Texas Southwestern Medical Center,Department Of Surgery,Dallas, TX, USA
Introduction: Unintentional injury is the leading cause of death in children 1-19 years and motor vehicle crashes (MVCs) are the most common cause of unintentional injury in this group. Previous research has demonstrated substantial variability in pediatric trauma resources at the state level. However, it is unclear how these differences in resources may affect actual access to care for pediatric trauma patients. We sought to examine the impact of state in which the crash occurred on prompt access to care for children involved in MVCs.
Methods: Using the 2010-2014 Fatality Analysis Reporting System, we assembled a cohort of child passengers (<15y) involved in a fatal MVC, defined as a crash occurring on a U.S. public road and resulting in ≥1 death (adult or pediatric) within 30 days. We included children requiring transport from the crash scene to a hospital for medical care for whom data on time of hospital arrival were available. Our primary outcome was time to first hospital, defined as a binary variable (>1h or ≤1h). We used multivariable logistic regression to establish the state-level variability of the percentage of children whose time to hospital was >1h, after adjusting for injury severity (no injury, possible injury, suspected minor injury, suspected severe injury, fatal injury, injury of unknown severity), mode of transport (Emergency Medical Services (EMS) air, EMS ground, other), and rural roads. We described variability by state, dividing states into quartiles according to the percentage of children delivered to the first hospital >1h after the fatal MVC.
Results: We identified 12,152 child passengers involved in a fatal MVC from 2010-2014; 4,672 (38.4%) required transport for medical care from the scene of the MVC. Of those not transported, 1,424 (19.0%) died at the scene. Of those transported, median time to first hospital was 1h (IQR: [1,1]; range: [0,87]). The percent of children that experienced transport times >1h varied significantly by state, from 0.0 in Rhode Island to 100.0 in Florida, Idaho, Indiana, and Michigan (p<0.001). While we observed striking state-level variation in transport times, there were no clear regional patterns (Figure).
Conclusions: Time to hospital varied greatly by U.S. state for children requiring transport for medical treatment from the scene of a fatal MVC. State-level resources for EMS services and the availability of pediatric trauma care may contribute to the availability of prompt trauma care for children involved in fatal MVCs. These results provide critical data to inform state-level trauma care planning.
