	Background

Children who have suffered a severe and potentially life threatening  physical injury as a result of an event such as a motor vehicle crash or a  fall need specialized care because of their unique anatomical,  physiological, and psychological characteristics. 1). Trauma care is an essential component of emergency care, which  encompasses all services involved in emergency medical care—both  injury and illness. For example, the Department of Health  and Human Services (HHS) Secretary can make grants and enter into  cooperative agreements and contracts to conduct and support research,  training, evaluations, and demonstration projects related to trauma care  and to foster the development of trauma care systems. Additionally, in  2006, HHS’ Health Resources and Services Administration (HRSA)  released the Model Trauma System Planning and Evaluation document, a  guide for trauma system development across the United States. An Estimated 57 Percent of Children Lived within 30 Miles of a High-Level Pediatric Trauma Center during the Period 2011- 2015, Although the Percentage Varied by State

Our analysis of data from the American Trauma Society and the Census  Bureau’s American Community Survey shows that 57 percent, or 41.9  million, of the estimated 73.7 million children in the United States lived  within 30 miles of a high-level pediatric trauma center during the period  2011-2015. These centers have the dedicated resources necessary to  treat all injuries, regardless of severity. In  areas without high-level pediatric trauma centers, children may have to  rely on adult trauma centers with the resources to treat injured patients,  even though these facilities are not specialized to treat children. Some Studies Suggest that Children Treated at Pediatric Trauma Centers Have a Lower Risk of Mortality, While Information on Other Outcomes Is Limited

Five of the studies we reviewed, including studies based on national data,  suggest that children treated at pediatric trauma centers have a lower risk  of mortality compared to children treated at other types of facilities. However, some of the  studies we reviewed and stakeholders we interviewed suggested that  data on pediatric outcomes is limited and that more information is needed  on outcomes other than mortality for children treated at pediatric trauma  centers. For example, two studies, which each examined data  for adolescents from a single state, did not identify significant differences  in mortality among adolescents treated at pediatric and adult trauma  centers. Data on other outcomes. Further, as some studies note, mortality can be a limited measure for  determining quality of care or a trauma center’s contribution to survival,  because overall mortality is low among severely injured children. One  2015 study found that adding a pediatric trauma center in Delaware  decreased the frequency of pediatric splenectomies—a procedure that  removes a child’s spleen. Two Federal Agencies Support Hospital-Based Pediatric Trauma Activities Primarily through Grants, While Other Efforts Broadly Address Emergency Care

Two agencies within HHS—HRSA and NIH—have  grant programs and  other activities that support hospital-based pediatric trauma care (see  table 2). Within HRSA, the Emergency Medical Services for Children (EMSC)  program, established in 1984, provides funding to states and academic  medical institutions. Federal Activities Related to Hospital-Based Pediatric Trauma Care and Other Emergency Care Are Coordinated through an Interagency Group and Arrangements between Agencies

HRSA and NIH  officials reported that activities related to hospital-based  trauma care and other emergency care, including pediatrics, are  coordinated through an interagency group and through arrangements  between individual agencies (see table 3). Both HRSA and NIH  representatives are executive committee members of the Council on  Emergency Medical Care, a federal interagency group led by ASPR’s  Emergency Care Coordination Center, a center specially created as the  policy lead for emergency care activities across the federal government. Agency Comments

We provided a draft of this report to HHS for comment. The department  provided technical comments, which we incorporated as appropriate.
Why GAO Did This Study

Pediatric trauma—a severe and potentially disabling or life threatening injury to a child resulting from an event such as a motor vehicle crash or a fall—is the leading cause of disability for children in the United States. More children die of injury each year than from all other causes combined. GAO was asked to examine issues related to pediatric trauma care.
This report examines (1) what is known about the availability of trauma centers for children and the outcomes for children treated at different types of facilities, and (2) how, if at all, federal agencies are involved in supporting pediatric trauma care and how these activities are coordinated. GAO analyzed data on the number of pediatric and adult trauma centers in the United States relative to the pediatric population under 18 years of age. GAO used 2015 data on trauma centers from the American Trauma Society's Trauma Information Exchange Program and 5-year population estimates for 2011-2015 from the U.S. Census Bureau's American Community Survey, which were the latest available data at the time of GAO's analysis. GAO also reviewed the existing peer-reviewed, academic literature on outcomes for pediatric trauma patients, interviewed stakeholder group representatives and federal agency officials involved in activities related to hospital-based pediatric trauma care, and reviewed available agency documentation.
HHS provided technical comments on a draft of this report, which GAO incorporated as appropriate.

What GAO Found

GAO estimates that 57 percent of the 73.7 million children in the United States during the period 2011-2015 lived within 30 miles of a pediatric trauma center that can treat all injuries regardless of severity. Among states, the proportion of children who lived within 30 miles of these pediatric trauma centers varied widely. In areas without pediatric trauma centers, injured children may have to rely on adult trauma centers or less specialized hospital emergency departments for initial trauma care. Some studies GAO reviewed, including nationwide studies, found that children treated at pediatric trauma centers have a lower mortality risk compared to children treated at adult trauma centers and other facilities, while other state-level studies GAO reviewed found no difference in mortality. Further, some studies GAO reviewed and stakeholders GAO interviewed suggest that more information is needed on outcomes other than mortality for children treated at pediatric trauma centers because mortality can be a limited outcome measure, as overall mortality is low among severely injured children.
Two agencies within the Department of Health and Human Services (HHS)—the Health Resources and Services Administration (HRSA) and the National Institutes of Health (NIH)—have grant programs and other activities that support hospital-based pediatric trauma care. For example, HRSA's Emergency Medical Services for Children Program provides grants to integrate pediatric emergency care—which encompasses care for both traumatic injury and illness—into states' larger emergency medical services systems. GAO also found that federal activities related to hospital-based pediatric trauma care and other emergency care are coordinated through an interagency group and arrangements among agencies. For example, HRSA and NIH staff participate in the Council on Emergency Medical Care, an interagency group established to coordinate emergency care activities across the federal government by promoting information sharing and policy development.