Several projects fall into the scope of this research:
Where are Injuries Occuring?
The National Trauma Registry includes all cases of injury-related hospitalizations in Canada. Data from here, linked to data from Statistics Canada will be used to create a spatial picture of the distribution of pediatric injury hospitalization cases across the country using the postal codes of residence – based on mapping incidence. Detailed distribution of cases will be stratified in several ways:
- By age (young children 0-5 years; children 6-12 years; youth 13-18 years)
- By disadvantaged populations (e.g. Aboriginal; Census areas with a high Child and a unique Youth Vulnerability Index; rural with long road travel distance to major pediatric trauma centers)
- By vulnerable/high risk injury mechanisms, including motor vehicle crashes, pedestrian injuries and snowboard injuries
- By vulnerable high risk injury patterns, including those with an Injury Severity Score (ISS) >11 and those with traumatic brain injuries.
Who is the Right Patient?
To determine “who the right patient is,” we will conduct an extensive literature review to elucidate what specific injury patterns have better outcomes when managed at centers with dedicated pediatric trauma care. This literature is limited at present, thus local and national experts (in collaboration with the Trauma Association of Canada and the various Canadian pediatric surgical associations) will be consulted. These experts will be surveyed and will participate in a modified Delphi process to determine which patients are most appropriately cared for in higher level pediatric trauma centers (based on mechanism, injury pattern and/or patient characteristics (e.g. age).
Is the Right Patient getting to the Right Place? What are Potential barriers to Access?
Using descriptors of the “right patient”, maps will be prepared that will display the proportion of patients across the country reaching appropriate higher versus lower levels of care. The influence of vulnerability factors on the risk of not reaching appropriate levels of care will be analyzed to determine if they pose additional barriers to appropriate access.