Rural vs. Urban Pediatric Trauma Care and Potential for State-Wide Standardization: A Survey of Trauma Providers and Program Managers
Caroline Stephens, BA1; Arjun Ashok, BS1; David Lehrfeld, MD2; Arvin Gee, MD, PhD1; Mubeen Jafri, MD1; Criag Newgard, MD, MPH1; Sanjay Krishnaswami, MD1
1Oregon Health & Sciences University, Portland, OR; 2Oregon Health Authority, Portland, OR
Purpose: Rural/urban disparities in trauma outcomes are well documented. However, few studies examine how differences in setting and resources impact rural providers' approach to pediatric trauma. We sought to understand how management of injured children varied across our state and to assess the potential for standardization.
Methods: A statewide, cross-sectional survey was distributed by email to trauma providers/managers through state-government/American College of Surgeons/Medical Board lists. Topics included pediatric management processes, challenges, and transfer/admission procedures. Rural-urban commuting codes were used to categorize responses.
Results: Overall, 56 of 68 respondents cared for children, representing 72% of counties with hospitals, with 58% practicing rurally, and 22% at critical access hospitals. While participants had similar problems with human resources, rural providers experienced lower trauma volumes (<1 patient/month, 63%vs.0%, p<0.001), more difficulties getting pediatric-appropriate material resources, and challenges caring for infants/toddlers (Figure). Despite most rural providers (77%) stating <10% of patients had multisystem injuries, more used full-body CT often (41%vs.10%, p=0.007). Transfer interruptions were common (93%), with 44% cancelling transfers. The majority supported admission/transfer (85%) and imaging (82%) protocols.
Conclusions: Rural providers experience lower pediatric trauma volumes, greater material-resource issues and discomfort with small children. Furthermore, lack of standardized processes may lead to reliance on full-body CT, and potentially avoidable/complicated transfers. Given rural interest, adoption of standardized protocols can facilitate a state-wide, collaborative approach to pediatric trauma management.
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