Mapping US pediatric hospitals and subspecialty critical care for public health preparedness and disaster response, 2008.
OBJECTIVE
The objective is to describe by geographic proximity the extent to which the US pediatric population (aged 0-17 years) has access to pediatric and other specialized critical care facilities, and to highlight regional differences in population and critical resource distribution for preparedness planning and utilization during a mass public health disaster.


METHODS
The analysis focused on pediatric hospitals and pediatric and general medical/surgical hospitals with specialized pediatric critical care capabilities, including pediatric intensive care units (PICU), pediatric cardiac ICUs (PCICU), level I and II trauma and pediatric trauma centers, and general and pediatric burn centers. The proximity analysis uses a geographic information system overlay function: spatial buffers or zones of a defined radius are superimposed on a dasymetric map of the pediatric population. By comparing the population living within the zones to the total population, the proportion of children with access to each type of specialized unit can be estimated. The project was conducted in three steps: preparation of the geospatial layer of the pediatric population using dasymetric mapping methods; preparation of the geospatial layer for each resource zone including the identification, verification, and location of hospital facilities with the target resources; and proximity analysis of the pediatric population within these zones.


RESULTS
Nationally, 63.7% of the pediatric population lives within 50 miles of a pediatric hospital; 81.5% lives within 50 miles of a hospital with a PICU; 76.1% lives within 50 miles of a hospital with a PCICU; 80.2% lives within 50 miles of a level I or II trauma center; and 70.8% lives within 50 miles of a burn center. However, state-specific proportions vary from less than 10% to virtually 100%. Restricting the burn and trauma centers to pediatric units only decreases the national proportion to 26.3% for pediatric burn centers and 53.1% for pediatric trauma centers.


CONCLUSIONS
This geospatial analysis describes the current state of pediatric critical care hospital resources and provides a visual and analytic overview of existing gaps in local pediatric hospital coverage. It also highlights the use of dasymetric mapping as a tool for public health preparedness planning.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. mdb4@cdc.gov
Mary D
MD
Brantley
Hua
H
Lu
Wanda D
WD
Barfield
James B
JB
Holt
Alcia
A
Williams
D002053:Burn Units / Q000706:statistics & numerical data; D002648:Child; D003422:Critical Care / Q000706:statistics & numerical data*; D004189:Disaster Planning / Q000379:methods / Q000706:statistics & numerical data*; D040362:Geographic Information Systems; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D020380:Needs Assessment / Q000706:statistics & numerical data; D011635:Public Health Administration / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000706:statistics & numerical data; D014481:United States