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The Spatial Epidemiology of Pediatric Trauma: A Statewide Assessment
Allison Ertl, MS, Yuhong Zhou, MS, ME, Kirsten Beyer, PhD, MPH, MS, Sergey Tarima, PhD, Jonathan I. Groner, MD and Laura D. Cassidy, MS, PhD, Medical College of Wisconsin, Milwaukee WI

Abstract:
Introduction: Despite significant advances in the prevention and treatment of pediatric trauma, preventable injuries continue to burden the lives of millions of children. In order to target prevention strategies, it is critical to identify areas with high burdens of pediatric trauma. Therefore, this study analyzed statewide data from the Ohio Trauma Registry (OTR) from 2007-2012 to identify geographical patterns in pediatric injury. Methods: Data from the first hospital of care for 17,377 pediatric trauma patients under 16 years old were analyzed using the disease mapping method adaptive spatial filtering to estimate a series of maps that display age- and sex-adjusted rates of pediatric trauma, severe trauma, and standardized mortality ratios (SMR) while controlling for population size to create stable estimates throughout the study area. The locations of all trauma centers were mapped to highlight access to trauma care. Results: Areas with significantly higher than expected rates of severe injury were identified in non-urban areas, where children lacked timely access to a Pediatric Trauma Center (PTC) or Level 1 Adult Trauma Center (ATC). Although highest SMRs were in urban areas, non-urban areas experienced elevated mortality with rates up to 6 times higher than expected. Conclusion: Areas with higher than expected age- and sex-adjusted rates of severe injury and mortality should be further explored to identify opportunities for injury prevention and appropriate access to timely care.
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Objective Content:
Identify geographical patterns of pediatric trauma outcomes and areas with significantly elevated pediatric trauma and mortality to inform opportunities for injury prevention and appropriate access to timely care.


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