title: The relationship between the location of pediatric intensive care unit facilities and child death from trauma: a county-level ecologic study.
abstract: OBJECTIVE
  To describe the relationship between the location of Pediatric Intensive Care Unit (PICU) facilities and county-level child death from trauma in the contiguous USA.
  
  
  METHODS
  We conducted a cross-sectional ecologic study using county-level data on death due to trauma in children 0 to 14 years of age from 1996 to 1998. These data were linked to 1997 county-level data on availability of PICU facilities.
  
  
  RESULTS
  In 1997, PICU facilities were present in 9% of USA counties. There were 18,337 childhood deaths from trauma in the study period. The presence of PICU facilities in a county was associated with lower mortality from trauma (incidence rate ratio [IRR] = 0.72; 95% CI 0.67-0.78) compared to counties without PICU facilities. After controlling for residence in rural and low-income counties, and the presence of adult medicosurgical intensive care units, the presence of PICU facilities in a county remained associated with lower rates of death from trauma (IRR = 0.82; 95% CI 0.75-0.89).
  
  
  CONCLUSIONS
  The presence of PICU facilities is related to lower mortality rates due to traumatic injuries at the county level. This finding may reflect the concentration of pediatric subspecialty care in counties with PICUs. This association merits further study with individual-level observations.
authors: Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, MI, USA. fodetola@med.umich.edu
authors: Folafoluwa O
authors: FO
authors: Odetola
authors: William C
authors: WC
authors: Miller
authors: Matthew M
authors: MM
authors: Davis
authors: Susan L
authors: SL
authors: Bratton
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000600:supply & distribution*; D015999:Multivariate Analysis; D011203:Poverty; D012044:Regression Analysis; D012111:Residence Characteristics; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*