A Population-Based Multivariate Analysis of the Association of County Demographic and Medical System Factors with Per Capita Pediatric Trauma Death Rates in North Carolina

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Abstract
This study analyzed the association between demographic and medical system factors and the pediatric trauma death rate in North Carolina. Trauma is the leading cause of death in children. Various medical system factors have been suggested to reduce pediatric morbidity and mortality rates, but the association with these rates has not been tested. Data were obtained from the North Carolina medical examiner's database. The dependent variable was the county per capita pediatric trauma death rate. Twenty-one demographic and medical system measures were selected as independent variables. Nine hundred forty-one pediatric trauma deaths from 1986 to 1989 were included in our sample. Multivariate analysis identified the variables most highly associated with the dependent variables. The presence of advanced life support (ALS) training was the only medical system factor associated significantly with pediatric trauma death rates. Trauma centers, emergency (911) telephone access, and other medical resource variables had no significant association. The study confirms other reports showing that demographic factors have an important predictive association with the trauma death rate in children. Advanced life support was the only medical system resource associated significantly with pediatric trauma death rates. This study underlines the significance of pre-hospital care in the treatment of pediatric trauma.

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