• Folafoluwa O Odetola, William C Miller, Matthew M Davis, and Susan L Bratton.
• Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, MI, USA. fodetola@med.umich.edu
• J. Pediatr. 2005 Jul 1;147(1):74-7.

ObjectivesTo describe the relationship between the location of Pediatric Intensive Care Unit (PICU) facilities and county-level child death from trauma in the contiguous USA.Study DesignWe conducted a cross-sectional ecologic study using county-level data on death due to trauma in children 0 to 14 years of age from 1996 to 1998. These data were linked to 1997 county-level data on availability of PICU facilities.ResultsIn 1997, PICU facilities were present in 9% of USA counties. There were 18,337 childhood deaths from trauma in the study period. The presence of PICU facilities in a county was associated with lower mortality from trauma (incidence rate ratio [IRR] = 0.72; 95% CI 0.67-0.78) compared to counties without PICU facilities. After controlling for residence in rural and low-income counties, and the presence of adult medicosurgical intensive care units, the presence of PICU facilities in a county remained associated with lower rates of death from trauma (IRR = 0.82; 95% CI 0.75-0.89).ConclusionThe presence of PICU facilities is related to lower mortality rates due to traumatic injuries at the county level. This finding may reflect the concentration of pediatric subspecialty care in counties with PICUs. This association merits further study with individual-level observations.

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