Injury is the number one cause of death for children. Although it is known that underprivileged children have an increased trauma mortality, there is a significant gap in our knowledge about the role access to quality trauma care plays in disparate outcomes for injured children. Whether the higher mortality rate is caused by an increased incidence of severe injury or an increased death rate for a given injury (severity- adjusted mortality) is important because each require different healthcare delivery and policy interventions. If underprivileged children have higher severity of injury and more lethal mechanisms of injury this would call for programs focused on environmental and behavioral modification. However if children also die because of lack of access to quality trauma care, this implies the institutionalization of inequitable care. An under- standing of the forces that influence trauma access, as well as an assessment of the quality of care provided, are vital to improving outcomes for children with trauma and will allow providers and policy makers to target trauma prevention strategies and implement system changes that will improve overall outcomes. While it is known that specialized trauma care improves outcomes, a significant proportion of severely injured persons are cared for outside the trauma system, thus a population-based analysis is necessary. We will use 1990-2006 California Vital Statistics death certificate data, and California Office of Statewide Planning and Development Patient Discharge Database records to identify all injured children admitted to California hospitals or who died prior to hospitalization. We will first determine if socioeconomic status is associated with an increased rate of out of hospital death, increased hospitalization rate for a given injury (controlling for severity), or increased severity-adjusted mortality. We will develop a robust mortality prediction model for injured children using patient level variables which will allow us to assess the association of system level variables such as rural status, and hospital volume on risk adjusted mortality. We will also identify predictors of trauma care access for children. This research foundation will allow for exploratory analysis of county trauma registries to identify quality of care indicators for pediatric trauma care and to determine to what degree outcome disparities are associated with poorer quality of care. My long-term career goal is to translate my clinical experience into scientifically sound epidemiological studies that will directly benefit all children. In addition to completion of this research, this award will allow me to obtain an MPH and broaden my quantitative skills. After this award period, I will continue as an independent investigator to identify disparities in pediatric trauma outcomes, improve the quality of emergency medical care and design community, regional and state-wide system interventions to prevent pediatric trauma, reduce outcome disparities and improve the overall quality of care provided to injured children.
