The Conundrum of Maintaining Pediatric Readiness at Nonpediatric Designated Trauma Centers

INTRODUCTION: The American College of Surgeons (ACS) has recently highlighted the need for emergency departments to maintain pediatric readiness, regardless of pediatric trauma center verification. Since sufficient emergency department volume is often required to maintain pediatric competency, a more complete understanding of pediatric trauma volume at centers without ACS verification would help inform efforts to improve pediatric trauma readiness. METHODS: We conducted a retrospective descriptive analysis of public data sets from 2017 through 2023 from the Trauma Quality Improvement Program (TQIP) registry. We included encounters at non-pediatric-designated facilities with a documented age. We used deidentified facility keys to perform per-facility analyses. Based on previously published data, we used thresholds of <324, 324 to 899, 900 to 1799, and >1800 pediatric trauma encounters per year for low, medium-low, medium-high, and high volume. RESULTS: Among 5,805,596 trauma encounters with a documented age, 291,418 patients were younger than 15 years old and presented to a trauma center without pediatric verification. During the study period, most nondesignated centers saw at least 1 pediatric trauma patient, with a yearly median of 25 to 32 pediatric trauma encounters per non-pediatric-designated facility. The majority (97%) were in the lowest category of pediatric trauma volume (<324 cases per year). The yearly median encounters per facility with a composite injury severity score >15 were 1. For adult verified level 1, level 2, level 3, and unverified trauma centers, the median visits per year were 31, 31, 22, and 31, respectively. When assessed by age groups of younger than 4, 5 to 9 years, and 10 to 14 years, the median number of visits per year was 8, 9, and 11, respectively. CONCLUSIONS: Pediatric encounters at non-pediatric-designated trauma centers were very low, with few trauma centers having sufficient volume to sustain system-level readiness through patient care only. Our findings highlight ongoing challenges with maintaining pediatric readiness and point to the need for innovative methods to ensure a high level of pediatric readiness.