BACKGROUND: Children living in rural areas experience an increased incidence of injury and higher mortality relative to those in urban areas. Our aim was to better characterize rural-urban disparities in pediatric trauma outcomes among children admitted to US hospitals. METHODS: This is a retrospective, observational study of US hospitalizations of injured children and adolescents 25) increased (7.0% large urban, 7.9% small urban, 9.6% micropolitan, and 10.9% rural areas). When adjusted for risk of mortality, compared to large urban counties, rural county was associated with 32% higher odds odds ratio (OR), 1.32, 95% CI, 1.16–1.51, micropolitan 30% higher odds (OR, 1.30, 95% CI, 1.16–1.46), and small urban 22% higher odds (OR, 1.22, 95% CI, 1.12–1.32) of inpatient mortality. CONCLUSIONS: Among injured children admitted to US hospitals, children residing outside of large urban areas have a higher risk of death independent of injury severity. To address disparities in pediatric rural injury outcomes, we must further investigate the root causes of this disparity, which may include nonoptimal location of pediatric trauma centers, long transport times, and low pediatric readiness in rural hospitals. ( J Trauma Acute Care Surg. 2026;00:00–00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.) LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level III.
Butler et al. (Tue,) studied this question.