Available online 2 November 2022, 151222

Death and disability associated with traumatic injury can be significantly decreased with timely and appropriate care. Patients in rural areas tend to have disproportionately decreased access to this care, with the pediatric age group acting as a particularly difficult challenge for pre-hospital and rural hospital settings due to the unfamiliarity of those trauma response teams with pediatric age specific management guidelines as well as a disparity in resource availability. In this review, we attempt to discuss the challenges facing pediatric trauma care in the rural and low resourced communities, as well as initiatives that are being carried out to optimize this kind of care, such as pediatric readiness, rapid transportation to higher levels of care, availability of blood in rural centers as well as in transit, and the utility of telemedicine in improving rural pediatric trauma care.

Pediatric trauma remains the leading cause of death in children in the United States, with blunt injury accounting for approximately 90 percent of all pediatric trauma.1 Pediatric traumatic injury results in greater mortality than all other causes combined.2 As members of the surgical community, we shoulder a great deal of responsibility as emergency response leaders. When executed accurately and effectively, the trauma protocols established by our surgical societies can have an immense impact on survival outcomes in pediatric populations.

Pediatric trauma management is complicated by the fact that almost 1 in 6 children who are injured require Emergency Department (ED) care. Despite the presence of adult and pediatric trauma centers throughout the country, the gross mortality rate of injured children is approximately 10,000 per year.3 The majority of children injured in the country are not initially cared for in pediatric centers.4,5 A study of 53,113 pediatric trauma cases4,5 revealed that the overall survival rate of children

Pediatric readiness

Why is there a need to use the word ‘readiness’ when it comes to the care of our pediatric population? This stems from the fact that most of the medical community trains in an environment that is tailored towards treating the average 70 kg human adult. We are not ‘ready’ when it comes to the sudden changes in dosing, technique, and mindset that are essential to a pediatric trauma resuscitation. A retrospective cohort study of 832 emergency departments in US trauma centers

All pediatric trauma patients deserve access to timely and appropriate care. Through collaboration with the trauma systems at multiple levels and creative use of resources, rural and low resource sites will be able to support these children. In spite of injury prevention programs, all sites will continue to assess and manage pediatric trauma patients and preparedness is critical.

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