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Proximity to trauma care increases childhood survival after car crash
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Pediatric mortality rates related to motor vehicle crashes vary widely throughout the United States, and these variations can even be seen across individual counties, according to findings presented at the American College of Surgeons Clinical Congress. Researchers said that children have a higher likelihood of surviving a motor vehicle crash when they are closer to a pediatric or adult trauma center.
The CDC previously reported that motor vehicle crashes are one of the leading causes of accidental death among American youth and the leading cause of unintentional mortality among U.S. teenagers.
“We explored some county-level factors that may have led to these differences, and we found that metropolitan versus rural location and availability of a trauma center — particularly a pediatric one — were important factors,” Ali Mokdad, MD, MS, a surgical resident at the University of Texas Southwestern Medical Center, told Infectious Diseases in Children. “We hope, as academicians, that highlighting high-risk clusters with excessive mortality will help policy-makers guide resources and investigate the exact reasons that drive mortality up in certain areas.”
Mokdad and colleagues examined the deaths of children aged younger than 15 years reported in the Fatality Analysis Reporting System between 2010 and 2015. All deaths included in the study occurred within 30 days of a motor vehicle crash on a U.S. public road.
During the study period, the researchers identified 31,747 motor vehicle crashes resulting in a pediatric death. These children had an average age of 7 years.
In the U.S., the researchers calculated an overall average crude mortality rate of 1.4 deaths per 100,000 children annually. However, rates observed in different parts of the country varied greatly, with 0.1 deaths per 100,000 children reported in Suffolk County, Massachusetts (95% CI, 0-0.2) and 13.8 deaths per 100,000 children in La Paz County, Arizona (95% CI, 10.1-18.2)
According to Mokdad and colleagues, variation was also observed in states with more than 100,000 children. Texas, Arizona and Louisiana had the most counties with high mortality rates. Low mortality rates were observed in counties located in the Northeast, in California and near the Great Lakes.
The researchers said that although proximity to a pediatric or adult trauma center can reduce the mortality rate of a county, some areas with available trauma centers and some rural areas with fast response times still have high mortality rates.
“Adult trauma centers are much more available than pediatric trauma centers,” Mokdad said. “Out of the 3,142 counties included in the study, 103 had a pediatric trauma center. We do not necessarily need more trauma centers, but we may need trauma centers in more strategic locations and to improve on emergency medical service transfers so children are transferred to hospitals that are able to care for them best.” – by Katherine Bortz
Resources:
CDC: National Center for Health Statistics - Mortality among teenagers aged 12-19 years. https://www.cdc.gov/nchs/products/databriefs/db37.htm. Accessed October 23, 2018.
Mokdad AA, et al. Session SF218. Presented at: the American College of Surgeons Clinical Congress 2018. Oct. 20-25, 2018. Boston.
Disclosures: Infectious Diseases in Children was unable to confirm relevant financial disclosures prior to publication.