title: Pediatric trauma centers: correlation of ACS-verified trauma centers with CDC statewide pediatric mortality rates.
abstract: BACKGROUND
  Research on the impact of pediatric trauma centers (PTCs) on mortality has been conflicting, most likely owing to differing methodologies. Using a population-based approach, we assessed whether American College of Surgeons (ACS)-verified trauma centers are associated with reduced overall state pediatric injury mortality rates.
  
  
  METHODS
  A population-based study of state pediatric injury mortality rates (per 100,000 children ≤ 18 years) using data for 2008 from Centers for Disease Control and Prevention-National Center for Injury Prevention and Control. The availability of verified PTCs (vPTCs) and ACS-verified adult trauma centers in each state was determined and compared with mortality rates using regression, adjusting for injury mortality covariates. Correlation of mortality with type of trauma centers available was determined. The mortality versus number of PTCs per pediatric population was also examined.
  
  
  RESULTS
  vPTCs were present in 36% of states, including 24% of states with Level I vPTCs. The mean (SD) pediatric injury mortality for the 32 states without a vPTC was 20.6 (6.6) per 100,000 children 18 years or younger. Presence and higher verification level of vPTC within a state correlated with decreasing pediatric injury mortality (p(unadjusted)= 0.005; p(adjusted) = 0.004). Mortality was 37% lower among states with only Level I vPTCs (12.9 [2.2]). Mortality was inversely correlated with the number of Level I vPTCs (p(unadjusted) = 0.006; p(adjusted) = 0.06) and lowest for states with two Level I vPTCs (11.8 [1.7]). Higher ratios of Level I vPTCs per population correlated with lower mortality rates (β = -3.53, p = 0.003).
  
  
  CONCLUSIONS
  The findings highlight a correlation between state pediatric injury mortality rates and presence of ACS-verified Level I PTCs.
  
  
  METHODS
  Prognostic study, level IV.
authors.affiliation: Level I Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona 85016, USA. Dnotrica@surgery4children.com
authors.forename: David M
authors.initials: DM
authors.lastname: Notrica
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Weiss
authors.forename: Pamela
authors.initials: P
authors.lastname: Garcia-Filion
authors.forename: Erin
authors.initials: E
authors.lastname: Kuroiwa
authors.forename: Daxa
authors.initials: D
authors.lastname: Clarke
authors.forename: Melissa
authors.initials: M
authors.lastname: Harte
authors.forename: Jenessa
authors.initials: J
authors.lastname: Hill
authors.forename: Sally
authors.initials: S
authors.lastname: Moffat
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010372:Pediatrics; D012680:Sensitivity and Specificity; D012955:Societies, Medical / Q000592:standards; D016019:Survival Analysis; D014193:Trauma Centers / Q000592:standards*; D014481:United States; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy