title: Factors associated with the higher traumatic death rate among rural children.
abstract: OBJECTIVE
  To examine medical and demographic factors associated with traumatic deaths among children in Kentucky.
  
  
  METHODS
  This was a retrospective review and multiple regression analysis of all deaths in children younger than 18 years reported to the Kentucky Office of Vital Statistics from 1988 to 1992.
  
  
  RESULTS
  All 1,024 pediatric trauma deaths that occurred from 1988 to 1992 were analyzed. Death rates were calculated for each type of trauma for each county in the state. Motor vehicle accidents accounted for most of the pediatric deaths, but this finding was markedly age dependent. Death rates were higher in rural Kentucky for all forms of trauma and were highest in the Appalachian region. Multiple Poisson regression analysis identified variables associated with the traumatic pediatric death rates. Rural setting was associated with higher traumatic death rates, whereas the availability of a hospital with 24-hour emergency services in the county and the presence of advanced life support prehospital care were associated with lower death rates. Children in Appalachia were at an increased risk compared with other Kentucky children, even when we controlled for the rural nature of Appalachia.
  
  
  CONCLUSIONS
  Demographic and medical system factors are associated with traumatic death rates in Kentucky children. Access to care and advanced prehospital support were both significantly associated with lower pediatric death rates. Increased access to quality care and training of prehospital providers in advanced life support should be priorities in the planning of trauma systems for this state.
authors.affiliation: Department of Emergency Medicine, University of Kentucky, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Svenson
authors.forename: C
authors.initials: C
authors.lastname: Spurlock
authors.forename: M
authors.initials: M
authors.lastname: Nypaver
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D006285:Health Planning; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D009104:Multiple Trauma / Q000401:mortality*; D011159:Population Surveillance; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012423:Rural Health; D014504:Urban Health