title: Delayed family reunification of pediatric disaster survivors increases mortality and inpatient hospital costs: a simulation study.
abstract: BACKGROUND
  Disasters occur randomly and can severely tax the health care delivery system of affected and surrounding regions. A significant proportion of disaster survivors are children, who have unique medical, psychosocial, and logistical needs after a mass casualty event. Children are often transported to specialty centers after disasters for a higher level of pediatric care, but this can also lead to separation of these survivors from their families. In a recent theoretical article, we showed that the availability of a pediatric trauma center after a mass casualty event would decrease the time needed to definitively treat the pediatric survivor cohort and decrease pediatric mortality. However, we also found that if the pediatric center was too slow in admitting and discharging patients, these benefits were at risk of being lost as children became "trapped" in the slow center. We hypothesized that this effect could result in further increased mortality and greater costs.
  
  
  METHODS
  Here, we expand on these ideas to test this hypothesis via mathematical simulation. We examine how a delay in discharge of part of the pediatric cohort is predicted to affect mortality and the cost of inpatient care in the setting of our model.
  
  
  RESULTS
  We find that mortality would increase slightly (from 14.2%-16.1%), and the cost of inpatient care increases dramatically (by a factor of 21) if children are discharged at rates consistent with reported delays to reunification after a disaster from the literature.
  
  
  CONCLUSIONS
  Our results argue for the ongoing improvement of identification technology and logistics for rapid reunification of pediatric survivors with their families after mass casualty events.
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California 90027, USA.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Barthel
authors.forename: James R
authors.initials: JR
authors.lastname: Pierce
authors.forename: Allison L
authors.initials: AL
authors.lastname: Speer
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Levin
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Goodhue
authors.forename: Henri R
authors.initials: HR
authors.lastname: Ford
authors.forename: Tracy C
authors.initials: TC
authors.lastname: Grikscheit
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Upperman
mesh_terms: D000328:Adult; D002648:Child; D003198:Computer Simulation; D004190:Disasters / Q000706:statistics & numerical data*; D005190:Family; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D054527:Mass Casualty Incidents / Q000401:mortality; D008962:Models, Theoretical; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D010355:Patient Identification Systems / Q000706:statistics & numerical data; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000191:economics / Q000401:mortality*
keywords: Chemical kinetics; Compartmental model; Disaster medicine; Fluid model; Mathematical simulation; Pediatric surgery; Pediatric trauma; Poisson process; Queueing theory