ImportanceMature trauma systems are critical in building and maintaining national, state, and local resilience against all-hazard disasters. Currently, pediatric state trauma system plans are not standardized and thus are without concrete measures of potential effectiveness.ObjectiveTo develop objective measures of pediatric trauma system capability at the state level, hypothesizing significant variation in capabilities between states, and to provide a contemporary report on the status of national pediatric trauma system planning and development.Design, Setting, and ParticipantsA national survey was deployed in 2018 to perform a gap analysis of state pediatric trauma system capabilities. Four officials from each state were asked to complete the survey regarding extensive pediatric-related or specific trauma system parameters. Using these parameters, a panel of 14 individuals representing national stakeholder sectors in pediatric trauma care convened to identify the essential components of the ideal pediatric trauma system using Delphi methodology. Data analysis was conducted from March 16, 2019, to February 23, 2020.Main Outcomes and MeasuresBased on results from the national survey and consensus panel parameters, each state was given a composite score. The score was validated using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) fatal injury database.ResultsThe national survey had less than 10% missing data. The consensus panel reached agreement on 6 major domains of pediatric trauma systems (disaster, legislation/funding, access to care, injury prevention/recognition, quality improvement, pediatric readiness) and was used to develop the Pediatric Trauma System Assessment Score (PTSAS) based on 100 points. There was substantial variation across states, with state scores ranging from 48.5 to 100. Based on US CDC WONDER data, for every 1-point increase in PTSAS, there was a 0.12 per 100 000 decrease in mortality (95% CI, −0.22 to −0.02; P = .03).Conclusions and RelevanceResults of this cross-sectional study suggest that a more robust pediatric trauma system has a significant association with pediatric injury mortality. This study assessed the national landscape of capability and preparedness to provide pediatric trauma care at the state level. These parameters can tailor the maturation of children’s interests within a state trauma system and assist with future state, regional, and national planning.

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Objective: To describe risk factors associated with inappropriate antibiotic prescribing to children. Design: Cross-sectional, retrospective analysis of antibiotic prescribing to children, using Kentucky Medicaid medical and pharmacy claims data, 2017. Participants: Population-based sample of pediatric Medicaid patients and providers. Methods: Antibiotic prescriptions were identified from pharmacy claims and used to describe patient and provider characteristics. Associated medical claims were identified and linked to assign diagnoses. An existing classification scheme was applied to determine appropriateness of antibiotic prescriptions. Results: Overall, 10,787 providers wrote 779,813 antibiotic prescriptions for 328,515 children insured by Kentucky Medicaid in 2017. Moreover, 154,546 (19.8%) of these antibiotic prescriptions were appropriate, 358,026 (45.9%) were potentially appropriate, 163,654 (21.0%) were inappropriate, and 103,587 (13.3%) were not associated with a diagnosis. Half of all providers wrote 12 prescriptions or less to Medicaid children. The following child characteristics were associated with inappropriate antibiotic prescribing: residence in a rural area (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07–1.1), having a visit with an inappropriate prescriber (OR, 4.15; 95% CI, 4.1–4.2), age 0–2 years (OR, 1.39; 95% CI, 1.37–1.41), and presence of a chronic condition (OR, 1.31; 95% CI, 1.28–1.33). Conclusions: Inappropriate antibiotic prescribing to Kentucky Medicaid children is common. Provider and patient characteristics associated with inappropriate prescribing differ from those associated with higher volume. Claims data are useful to describe inappropriate use and could be a valuable metric for provider feedback reports. Policies are needed to support analysis and dissemination of antibiotic prescribing reports and should include all provider types and geographic areas.

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