Association Between US Pediatric Trauma Centers Access, Injury Burden and Socioeconomic Disadvantage

Introduction: Traumatic injury is the leading cause of pediatric mortality in the US. Prompt access to pediatric trauma centers (PTCs) is a key determinant of outcomes, yet racial, ethnic, and rural-urban disparities in access persist. We hypothesize that socioeconomically disadvantaged regions with high pediatric injury burden lack timely access to PTC.

Methods: We evaluated access to ACS-verified and self-designated PTC by calculating air and ground transport times to PTC per Census Block Group (BG). Using state-specific fatal and nonfatal pediatric injuries in 2019, we estimated the proportion of injuries within 60-minute-transport for each state and region. We trended BG’s median Area Deprivation Index (ADI; 0th-100th percentile, least-to-most disadvantaged) with transport time.

Results: The 2019 US pediatric population totaled 73,088,675, with 5,215,243 nonfatal and 8,875 fatal injuries. 66.8% of fatal pediatric injuries were estimated to occur in BGs within 60-minutes of a Level 1 PTC. Many southern states bore a higher national fatal injury burden despite a lower proportion of their populations having 60-minute-transport to a PTC (Figure 1). The difference in median ADI percentile among BGs with and without 60-minute access to a Level 1 PTC was 27.0 (43.0 versus 70.0, p<0.001) (Figure 2).

Conclusion: We found that some states with high fatal pediatric injury burden disproportionately lack timely PTC access and observed a trend between socioeconomic disadvantage and increased travel time to PTCs. Mitigating socioeconomic access disparities and expanding high-quality injury care to all children require optimizing geographic distributions of PTCs and maximizing pediatric readiness among all trauma centers.