Challenges in Geographic Access to Specialized Pediatric Burn Care in the United States

Jacob M. Dougherty, Eva S. Blake, Zhaohui Fan, Mary A. Hunter,Mark R. Hemmila,Naveen F. Sangji

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS（2024）

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Abstract

BACKGROUND:Geographical access to pediatric burn centers in the US is not well described. Patients may receive care at American Burn Association (ABA)-verified burn centers, unverified burn centers, or non-burn centers. A recent study indicated that most US counties do not have an ABA-verified pediatric burn center within 100 miles. However, access to unverified burn centers that provide care to pediatric burn patients was not considered. We studied access to all pediatric burn centers across different US regions, using American College of Surgeons (ACS) Committee on Trauma-verified pediatric trauma centers as a benchmark. STUDY DESIGN:An observational cohort study was conducted using 2022 US Census data. Individuals aged ≤14 years were included. Geographical location was determined by residence ZIP code. Pediatric burn centers were identified from the ABA directory. Pediatric trauma centers were identified by ACS verification status using the ACS Hospitals and Facilities directory. Population access to pediatric burn and trauma centers within 50, 100, and 300 miles of the home ZIP code was assessed. RESULTS:Of US children, 62.1%, 83.5%, and 98.6% live within 50, 100, and 300 miles of a pediatric burn center. Access to ABA-verified pediatric burn centers is lower compared to access to ACS-verified pediatric trauma centers. CONCLUSIONS:Overall, the US population has limited access to pediatric burn centers compared to pediatric trauma centers. The services offered and outcomes should be studied to better understand differences in the quality of care provided by verified and unverified centers.

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【要点】：研究分析了美国儿童对专业儿科烧伤中心的地理可及性，发现与儿科创伤中心相比，儿童对烧伤中心的地理可及性较低。

【方法】：通过观察性队列研究，使用2022年美国人口普查数据，评估了儿童居住地ZIP码与儿科烧伤中心及创伤中心的距离。

【实验】：研究使用了美国烧伤协会（ABA）目录识别儿科烧伤中心，美国外科医师学会（ACS）医院和设施目录验证儿科创伤中心，并评估了不同距离内儿童对烧伤中心和创伤中心的可及性，结果显示62.1%、83.5%和98.6%的美国儿童分别居住在距离儿科烧伤中心50英里、100英里和300英里以内。