Pediatric Trauma Center Utilization for Children Transported by Emergency Medical Services

OBJECTIVES: Pediatric trauma remains a leading cause of morbidity and mortality in the United States, and care at pediatric trauma centers (PTCs) is associated with improved outcomes. However, national patterns of emergency medical services (EMS) transport to PTCs for injured children meeting trauma center criteria are not well described. We sought to evaluate EMS transport patterns among injured children meeting American College of Surgeons (ACS) trauma center criteria and to identify factors associated with transport to a PTC. METHODS: We conducted a retrospective cohort study using the National EMS Information System (NEMSIS) public-release database from 2019-2022. We included patients younger than 16 years who were transported by EMS for injury and met ACS trauma center field triage criteria. Patient-level EMS data were linked with geographic information system (GIS) road network analyses of trauma center locations to assess geographic access to pediatric and general trauma centers. Geographic access was defined as being within a 60-minute ground transport interval to a trauma center. The primary outcome was EMS transport to a designated PTC among children meeting trauma criteria and with geographic access to a PTC. Secondary measures included patient demographics, injury characteristics, urbanicity, region, and EMS scene and transport intervals. Multivariable logistic regression was used to identify factors independently associated with transport to a PTC. RESULTS: Of 793,459 injured children transported by EMS, 97,985 (12.3%) met trauma center criteria. Among those with access to a PTC (n = 54,923, 56%), only 40.6% were transported to one. Males and children with firearm injuries were more likely to reach a PTC, whereas adolescents, suburban, or rural patients were less likely. Median transport interval was 20 minutes for PTC transports versus 15 minutes for others. CONCLUSIONS: Despite meeting field triage criteria and having geographic access, less than half of injured children meeting trauma center criteria were transported to PTCs. Interventions to increase appropriate transport to PTCs and enhance pediatric readiness at non-PTCs are needed to optimize trauma care for children.