title: Pediatric trauma systems: critical distinctions.
abstract: BACKGROUND
  Injured children represent 25% of all injured patients in the United States and have unique needs that may require treatment at a pediatric trauma center or a trauma center with pediatric commitment. This work attempts to determine if there is existing evidence that pediatric trauma centers, trauma centers with pediatric commitment, or trauma systems have improved the care of injured children.
  
  
  METHODS
  Published literature evaluating the impact on injured children of pediatric trauma centers, trauma centers with pediatric commitment, or trauma systems was reviewed. The studies were divided by the methodology used for evaluation: panel studies, trauma registry studies, and population-based studies.
  
  
  RESULTS
  Of the 18 studies reviewed, only 2 population-based studies evaluated the impact of trauma centers or systems on children. One found that a trauma center did not improve the injured child's risk of death. The other found that a statewide trauma system improved the risk of death in seriously injured children. A third population-based study found improved risk of death if the child was treated at an urban trauma center.
  
  
  CONCLUSIONS
  Further analysis is necessary to demonstrate whether trauma systems make a difference in pediatric outcome. Injury prevention will have the greatest impact on future pediatric injury outcomes.
authors.affiliation: Department of Surgery, School of Medicine, Oregon Health Sciences University, Portland 97201-3098, USA.
authors.forename: F
authors.initials: F
authors.lastname: Hulka
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D018672:Community Health Planning; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods; D012041:Regional Medical Programs / Q000706:statistics & numerical data*; D012042:Registries; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality