title: Impact of trauma system development on pediatric injury care.
abstract: OBJECTIVE
  Trauma systems improve survival by directing severely injured patients to trauma centers. This study analyzes the impact of trauma systems on pediatric triage and injury mortality rates.
  
  
  METHODS
  Population-based data were collected on injured children less than 15 years who were admitted to any hospital in New England from 1996 to 2006. Data from three trauma system states were compared to three non-trauma system states. The percentages of injured children, severely injured children, and brain-injured children admitted to trauma centers were determined as well as injury hospitalization and death rates. Time trend analysis examined the pace of change between the groups.
  
  
  RESULTS
  A total of 58,583 injured children were hospitalized during the study period. Injury hospitalization rates were initially similar between the two groups (with and without trauma systems) and decreased over time in both. Rates decreased more rapidly in trauma system states compared to those without, (P = 0.003). Injury death rates decreased over time in both groups with no difference between the groups, (P = 0.20). A higher percentage of injured children were admitted to trauma centers in non-trauma system states throughout the study period, and this percentage increased in both groups of states. A higher percentage of severely injured children and brain-injured children were admitted to trauma centers in non-trauma system states and both percentages increased over time. The increase was more rapid in trauma system states for children with severe injuries (P < 0.001) and children with brain injuries (P < 0.001).
  
  
  CONCLUSIONS
  Trauma systems decreased childhood injury hospitalization rates and increased the percentage of severely injured children and brain-injured children admitted to trauma centers. Mortality and overall triage rates were unaffected.
authors.affiliation: Trauma Program, Department of Surgery, Children's Hospital Boston and Harvard Medical School, 300 Longwood Avenue, Fegan 3, Boston, MA 02115, USA. David.Mooney@childrens.harvard.edu
authors.forename: David P
authors.initials: DP
authors.lastname: Mooney
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Gutierrez
authors.forename: Qiaoli
authors.initials: Q
authors.lastname: Chen
authors.forename: Peter W
authors.initials: PW
authors.lastname: Forbes
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D009511:New England / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014218:Triage / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology*