Building Verification-Ready Pediatric Injury Prevention Programs: A Four-Step Framework and Implementation Lessons Learned

Pediatric injury remains a leading cause of morbidity and mortality in the United States, disproportionately affecting children and families facing structural barriers related to cost, language, and access to safety resources. Trauma centers are expected to lead injury prevention yet report limited funding, time, and specialized staff. This single-center implementation study (September 2021-December 2024) presents a four-step BUILD→SUSTAIN framework for establishing verification-ready pediatric injury prevention programs and demonstrates its application through registry validation and analysis. The framework operates in two phases: BUILD, for sequential infrastructure establishment, and SUSTAIN, for iterative refinement, monitoring, and program evaluation. At an urban Midwestern pediatric Level I trauma center, BUILD implemented evidence-based interventions-car seat education, expectant-parent safety classes, and bicycle helmet distribution-through community partnerships prioritizing families facing cost, language, and access barriers. BUILD supported American College of Surgeons Level I pediatric trauma center verification within 24 months and American Burn Association verification, with 145 car seats and approximately 390 helmets distributed at no cost. SUSTAIN-phase registry validation identified a 4% all-mechanism misclassification rate, underscoring the importance of data quality for equitable prevention priorities. Among 210 motor vehicle collision cases (September 2021-December 2024), 19.5% were unrestrained, with approximately twice the odds of admission versus restrained patients; 88% of unrestrained children were age 12 or younger, within the ages targeted by existing programming. This framework offers mid-sized trauma centers a practical roadmap for developing verification-ready prevention infrastructure integrating community engagement with data validation, treating prevention as core trauma system infrastructure rather than a compliance activity.