Hostname: page-component-77c89778f8-swr86 Total loading time: 0 Render date: 2024-07-18T03:11:44.340Z Has data issue: false hasContentIssue false

Mapping US Pediatric Hospitals and Subspecialty Critical Care for Public Health Preparedness and Disaster Response, 2008

Published online by Cambridge University Press:  08 April 2013


Objective: The objective is to describe by geographic proximity the extent to which the US pediatric population (aged 0-17 years) has access to pediatric and other specialized critical care facilities, and to highlight regional differences in population and critical resource distribution for preparedness planning and utilization during a mass public health disaster.

Methods: The analysis focused on pediatric hospitals and pediatric and general medical/surgical hospitals with specialized pediatric critical care capabilities, including pediatric intensive care units (PICU), pediatric cardiac ICUs (PCICU), level I and II trauma and pediatric trauma centers, and general and pediatric burn centers. The proximity analysis uses a geographic information system overlay function: spatial buffers or zones of a defined radius are superimposed on a dasymetric map of the pediatric population. By comparing the population living within the zones to the total population, the proportion of children with access to each type of specialized unit can be estimated. The project was conducted in three steps: preparation of the geospatial layer of the pediatric population using dasymetric mapping methods; preparation of the geospatial layer for each resource zone including the identification, verification, and location of hospital facilities with the target resources; and proximity analysis of the pediatric population within these zones.

Results: Nationally, 63.7% of the pediatric population lives within 50 miles of a pediatric hospital; 81.5% lives within 50 miles of a hospital with a PICU; 76.1% lives within 50 miles of a hospital with a PCICU; 80.2% lives within 50 miles of a level I or II trauma center; and 70.8% lives within 50 miles of a burn center. However, state-specific proportions vary from less than 10% to virtually 100%. Restricting the burn and trauma centers to pediatric units only decreases the national proportion to 26.3% for pediatric burn centers and 53.1% for pediatric trauma centers.

Conclusions: This geospatial analysis describes the current state of pediatric critical care hospital resources and provides a visual and analytic overview of existing gaps in local pediatric hospital coverage. It also highlights the use of dasymetric mapping as a tool for public health preparedness planning.

(Disaster Med Public Health Preparedness. 2012;6:117–125)

Original Research
Copyright © Society for Disaster Medicine and Public Health, Inc. 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



1.Bravata, DM, McDonald, KM, Owens, DK, et alRegionalization of Bioterrorism Preparedness and Response. Rockville, Maryland: Agency for Healthcare, Research and Quality. 2004. No. 04-E016-2.Google Scholar
2.Graham, J, Shirm, S, Liggin, R, Aitken, ME, Dick, R.Mass-casualty events at schools: a national preparedness survey. Pediatrics. 2006;117 (1):e8e15.Google Scholar
3.Louie, JK, Acosta, M, Jamieson, DJ, Honein, MACalifornia Pandemic (H1N1) Working Group. Severe 2009 H1N1 influenza in pregnant and postpartum women in California. N Engl J Med. 2010;362 (1):2735.CrossRefGoogle ScholarPubMed
4.Lasswell, SM, Barfield, WD, Rochat, RW, Blackmon, L.Perinatal regionalization for very low-birth-weight and very preterm infants: a meta-analysis. JAMA. 2010;304 (9):9921000.Google Scholar
5.Pollack, MM, Alexander, SR, Clarke, N, Ruttimann, UE, Tesselaar, HM, Bachulis, AC.Improved outcomes from tertiary center pediatric intensive care: a statewide comparison of tertiary and nontertiary care facilities. Crit Care Med. 1991;19 (2):150159.Google Scholar
6.Tilford, JM, Simpson, PM, Green, JW, Lensing, S, Fiser, DH.Volume-outcome relationships in pediatric intensive care units. Pediatrics. 2000;106 (2, pt 1):289294.Google Scholar
7.Osler, TM, Vane, DW, Tepas, JJ, Rogers, FB, Shackford, SR, Badger, GJ.Do pediatric trauma centers have better survival rates than adult trauma centers? an examination of the National Pediatric Trauma Registry. J Trauma. 2001;50 (1):96101.Google Scholar
8.Densmore, JC, Lim, HJ, Oldham, KT, Guice, KS.Outcomes and delivery of care in pediatric injury. J Pediatr Surg. 2006;41 (1):9298, discussion 92-98.Google Scholar
9.Petrosyan, M, Guner, YS, Emami, CN, Ford, HR.Disparities in the delivery of pediatric trauma care. J Trauma. 2009;67 2(suppl)S114S119.Google Scholar
10.Hartman, M, Watson, RS, Linde-Zwirble, W, et alPediatric traumatic brain injury is inconsistently regionalized in the United States. Pediatrics. 2008;122 (1):e172e180.Google Scholar
11.Kanter, RK.Regional variation in child mortality at hospitals lacking a pediatric intensive care unit. Crit Care Med. 2002;30 (1):9499.CrossRefGoogle ScholarPubMed
12.American Hospital Association. Annual Survey of Hospitals Database.2009. Accessed March 28, 2012.Google Scholar
13.Lorch, SA, Myers, S, Carr, B.The regionalization of pediatric health care. Pediatrics. 2010;126 (6):11821190.Google Scholar
14.Committee On Child Health Financing. Scope of health care benefits for children from birth through age 26. Pediatrics. 2012;129 (1):185189.Google Scholar
15.US Census Bureau. United States—States and Puerto Rico GCT-PH1. Population, Housing Units, Area, and Density: 2000; Dataset: Census 2000 Summary File 1 (SF 1) 100-Percent Data. Scholar
16.US Census Bureau. Census 2000 Urban and Rural Classification; Source: Final Federal Register Notice for Urban Area Criteria. March 15, 2002;l67(No.51):11663-11670. Scholar
17.Mennis, J.Dasymetric mapping for estimating population in small areas. Geography Compass. 2009;3 (2):727745.Google Scholar
18.National Geospatial Intelligence Agency. Homeland Security Infrastructure Program (HSIP) Gold 2010 database. Scholar
19.Stroud, MH, Prodhan, P, Moss, MM, Anand, KJS.Redefining the golden hour in pediatric transport. Pediatr Crit Care Med. 2008;9 (4):435437 doi: 10.1097/PCC.0b013e318172da62.CrossRefGoogle ScholarPubMed
20.Lerner, EB, Moscati, RM.The golden hour: scientific fact or medical “urban legend”? Acad Emerg Med. 2001;8 (7):758760.Google Scholar
21.Original data supporting the “Golden Hour” concept produced from French World War I data. Trauma Resuscitation at Accessed June 1, 2010.Google Scholar
22.Burn Centers in the United States and Canada. Washington, DC:International Association of Fire Fighters' Burn Foundation; 2006. Scholar
23.Yantzi, N, Rosenberg, MW, Burke, SO, Harrison, MB.The impacts of distance to hospital on families with a child with a chronic condition. Soc Sci Med. 2001;52 (12):17771791.Google Scholar
24.Mobley, LR, Frech, T.Managed Care, Distance Traveled, and Hospital Market Definition. Dep of Economics, University of California at Santa Barbara (USCB); 1998. Economics Working Paper Series 13-98.Google Scholar
25.National Center for Health Statistics. U.S. Census Populations With Bridged Race Categories. January 21, 2010. Scholar
26.Multi-Resolution Land Characteristics Consortium (MRLC). About the MRLC Program. Accessed October 28, 2009.Google Scholar
27.Verified Trauma Centers. American College of Surgeons Committee on Trauma. American College of Surgeons, Chicago, Illinois; 2010. Scholar
28.Moritz, R.Consultant says trauma system taking shape. Arkansas News. April 23, 2010. Scholar
29.Access to Trauma Centers in the U.S. American Trauma Society-CDC Online. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (NCIPC), Atlanta, Georgia. 2010. Scholar
30.Burn Care Facilities. United States. American Burn Association, Chicago, Illinois; 2010. Scholar
31.Chang, R-KR, Klitzner, TS.Can regionalization decrease the number of deaths for children who undergo cardiac surgery? a theoretical analysis. Pediatrics. 2002;109 (2):173181.Google Scholar
32.Aharonson-Daniel, L, Waisman, Y, Dannon, YL, Peleg, KMembers of the Israel Trauma Group. Epidemiology of terror-related versus non-terror-related traumatic injury in children. Pediatrics. 2003;112 (4):e280.Google Scholar
33.Centers for Disease Control and Prevention. Predicting casualty severity and hospital capacity.2003. Accessed January 6, 2010.Google Scholar
34.Peleg, K, Aharonson-Daniel, L, Stein, M, et alIsraeli Trauma Group (ITG). Gunshot and explosion injuries: characteristics, outcomes, and implications for care of terror-related injuries in Israel. Ann Surg. 2004;239 (3):311318.Google Scholar
35.Burkle, FM Jr, Williams, A, Kissoon, NTask Force for Pediatric Emergency Mass Critical Care. Pediatric emergency mass critical care: the role of community preparedness in conserving critical care resources. Pediatr Crit Care Med. 2011;12 6(suppl)S141S151.Google Scholar
36.Task Force for Mass Critical Care. Definitive care for the critically ill during a disaster. Chest. 2008;133(suppl 5)1S66S.Google Scholar
37.Markenson, D, Reynolds, SAmerican Academy of Pediatrics Committee on Pediatric Emergency Medicine; Task Force on Terrorism. The pediatrician and disaster preparedness. Pediatrics. 2006;117 (2):e340e362.Google Scholar
38.Kanter, RK, Dexter, F.Criteria for identification of comprehensive pediatric hospitals and referral regions. J Pediatr. 2005;146 (1):2629.Google Scholar
39.Marcin, JP, Ellis, J, Mawis, R, Nagrampa, E, Nesbitt, TS, Dimand, RJ.Using telemedicine to provide pediatric subspecialty care to children with special health care needs in an underserved rural community. Pediatrics. 2004;113 (1, pt 1):16.Google Scholar
40.Spooner, SA, Gotlieb, EMCommittee on Clinical Information Technology; Committee on Medical Liability. Telemedicine: pediatric applications. Pediatrics. 2004;113 (6):e639e643.Google Scholar
41.Marcin, JP, Schepps, DE, Page, KA, Struve, SN, Nagrampa, E, Dimand, RJ.The use of telemedicine to provide pediatric critical care consultations to pediatric trauma patients admitted to a remote trauma intensive care unit: a preliminary report. Pediatr Crit Care Med. 2004;5 (3):251256.Google Scholar
42.Barfield, WD, Krug, SE, Kanter, RK, et alTask Force for Pediatric Emergency Mass Critical Care. Neonatal and pediatric regionalized systems in pediatric emergency mass critical care. Pediatr Crit Care Med. 2011;12 6(suppl)S128S134.Google Scholar