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J Surg Res. 2017 Sep;217:75-83.e1. doi: 10.1016/j.jss.2017.04.034. Epub 2017 May 8.

State-level geographic variation in prompt access to care for children after motor vehicle crashes.

Author information

1
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: llwolf@bwh.harvard.edu.
2
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
3
Department of Trauma Services, Children's Medical Center of Dallas, Part of Children's Health(SM), Dallas, Texas.
4
Orthopaedic and Arthritis Center for Outcomes Research and Policy, Innovation Evaluation in Orthopedic Treatments Research Center, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
5
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
6
Department of Trauma Services, Children's Medical Center of Dallas, Part of Children's Health(SM), Dallas, Texas; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

Abstract

BACKGROUND:

Motor vehicle crashes (MVCs) are a principal cause of death in children; fatal MVCs and pediatric trauma resources vary by state. We sought to examine state-level variability in and predictors of prompt access to care for children in MVCs.

MATERIALS AND METHODS:

Using the 2010-2014 Fatality Analysis Reporting System, we identified passengers aged <15 y involved in fatal MVCs (crashes on US public roads with ≥1 death, adult or pediatric, within 30 d). We included children requiring transport for medical care from the crash scene with documented time of hospital arrival. Our primary outcome was transport time to first hospital, defined as >1 or ≤1 h. We used multivariable logistic regression to establish state-level variability in the percentage of children with transport time >1 h, adjusting for injury severity (no injury, possible injury, suspected minor injury, suspected severe injury, fatal injury, and unknown severity), mode of transport (emergency medical services [EMS] air, EMS ground, and non-EMS), and rural roads.

RESULTS:

We identified 18,116 children involved in fatal MVCs from 2010 to 2014; 10,407 (57%) required transport for medical care. Median transport time was 1 h (interquartile range: [1, 1]; range: [0, 23]). The percent of children with transport time >1 h varied significantly by state, from 0% in several states to 69% in New Mexico. Children with no injuries identified at the scene and crashes on rural roads were more likely to have transport times >1 h.

CONCLUSIONS:

Transport times for children after fatal MVCs varied substantially across states. These results may inform state-level pediatric trauma response planning.

KEYWORDS:

Access to care; Fatality analysis reporting system; Motor vehicle crashes; Pediatric trauma; Transport time

PMID:
28558908
PMCID:
PMC5603370
DOI:
10.1016/j.jss.2017.04.034
[Indexed for MEDLINE]
Free PMC Article

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