Written by Catherine Burger
Spoon Feed
If all US trauma centers (level I – III) developed high pediatric readiness scores, an additional 14 million children would have access to the proven mortality benefits of trauma care delivered at pediatric ready centers.
Can kids get to a pediatric ready trauma center within the golden hour?
This 2023 descriptive, cross-sectional study evaluated what percent of American children are within 60 minutes of air or ground EMS travel to a high-level trauma center (level I, II or III), a trauma center with a high weighted pediatric readiness score (wPRS of at least 93 out of 100 – top quartile), or a pediatric trauma center (level I or II). Population density was estimated using the 2020 US census, hospital trauma designation, and pediatric readiness was gathered from national organization lists, government websites, online searches, and the 2021 National Pediatric Readiness Project (NPRP) assessment. Transport time calculations used rural and urban population centers, and were based on national EMS arrival, on-scene, and transport averages. Authors found that 92% of 74 million children were within 60 minutes of any trauma center, 73% were within 60 minutes of a trauma center with a high wPRS score, and 65% were within 60 minutes of a pediatric trauma center. Although there has been a national push to improve pediatric readiness, only 25% of all high-level trauma centers had a high wPRS. Children in rural areas, compared to urban, were more likely to have transport times greater than 60 minutes.
Studies show that injured children who present to pediatric ready centers (those with high wPRS or pediatric trauma centers) have significantly improved mortality as compared to centers with lower wPRS. Although access to pediatric trauma centers has not significantly changed in the past 15 years, education leading to higher wPRS has resulted in improved access to care for 5.5 million children thus far. If all high-level trauma centers were to improve their wPRS, an additional 14 million children would gain access to pediatric-ready trauma care. The NPRP provides free online learning resources and tools for hospital assessment supported by the American Academy of Pediatrics and the American College of Emergency Physicians. In 2022 the American College of Surgeons added NPRP wPRS assessment and plan for improving readiness to the trauma center verification process. US children living in rural areas currently have the greatest gaps in access to pediatric ready care and would likely benefit the most from improved wPRS at all trauma centers.
How will this change my practice?
Through outreach and education, I will continue to do all that I can to support clinically-proven assessments and training (such as NPRP resources) to help all emergency departments be optimally prepared to take care of injured children.
Source
Pediatric Readiness and Trauma Center Access for Children. JAMA Pediatr. 2025 Feb 3:e246058. doi: 10.1001/jamapediatrics.2024.6058. Epub ahead of print. PMID: 39899287
