Disparities in the delivery of pediatric trauma care.
BACKGROUND
Trauma is the leading cause of morbidity and mortality in children. During the last few decades, trauma systems have evolved to improve the care of the injured with an ultimate goal of saving lives. As a result, pediatric trauma centers (PTC) have been established to optimize outcomes for injured children. We sought to determine whether injured children treated at PTC or adult trauma centers (ATC) with added qualifications to treat injured children receive better trauma care than those treated at other hospitals or trauma centers.


METHODS
We reviewed more than 60 published studies on pediatric trauma outcomes. The studies included registry analysis: single and multihospital experience; abdominal, head and neck, and thoracic trauma; as well as functional outcomes.


RESULTS
The data show that most injured children are not treated at PTC due to the geographically limited distribution of such specialized care, lack of pediatric surgeons, and other specialists. These limitations create persistent disparities in outcomes for injured children depending on where they are treated. Some of the larger database analyses suggest lower mortality rate, better outcome for nonoperative treatment of blunt abdominal injuries, and improved overall functional outcome for those children treated at PTC. However, others fail to demonstrate differences for children treated at ATC or ATC with added qualifications.


CONCLUSIONS
Although this analysis does not provide a definitive answer to the question as to which type of trauma center provides better care for injured pediatric patients, it identifies current gaps and disparities in the care of injured children that can be remedied through education and training.
Petrosyan
Mikael
M
Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Guner
Yigit S
YS
Emami
Claudia N
CN
Ford
Henri R
HR
D002648:Child; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D014193:Trauma Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000628:therapy*