One in four children misses care at a pediatric trauma center

By Dr. Liji Thomas, MDReviewed by Lauren HardakerDec 17 2025

Where a child is injured in Canada can still determine whether they reach specialized trauma care. New national data reveal who it left out and why.

Study: Access to pediatric trauma centres in Canada: a population-based retrospective cohort study. Image credit: Sergey Mikheev/Shutterstock.com

Children who suffer major trauma are best treated in pediatric trauma centers. A recent study published in the journal CMAJ examined the accessibility of such centers in Canada, focusing on the proportion of needy children who attended them.

Specialized trauma care prevents death and disability

Trauma continues to be the single greatest contributor to deaths among children in Canada. In 2018 alone, there were 202 deaths from trauma among children up to 14 years old, and 3,574 children were left disabled. A total of 14,237 hospital admissions occurred in this demographic, along with 818,166 emergency department visits. This accounts for nearly three billion dollars in economic terms.

This impact could be softened by providing good trauma care, a key aspect being timely access to specialized centers. Each Canadian province has had its trauma system in place since the 1980s. These comprise acute care hospital networks for each geographic zone, spanning several levels of care, with pediatric trauma centers being Level I and II hospitals.

Children with major trauma are 41 % less likely to die if treated at pediatric vs adult trauma centers. They also require significantly fewer emergency surgeries and imaging procedures. Previous studies have explored the potential and realized access to such centers in North America.

The current study aimed to find the proportion of children with major trauma who accessed a pediatric trauma center in Canada, and identify differences with age, severity of trauma, the part injured, and mechanism of injury.

Tracking access to pediatric trauma care

The study used a population-based cohort design covering children aged up to 16 years who were hospitalized for major trauma across nine provinces (excluding Quebec). The Injury Severity Score was used to identify major trauma based on anatomical and severity classifications. In all cases, the score was over 12.

The researchers estimated the rate of access to such a center across the provinces, using Poisson regression, stratifying by age and severity of injury.

Access varies by age, injury severity, and province

The study covered 3,007 children hospitalized in acute care centers with major trauma, the mean age being about nine years. While ~64 % were male, 18 % were critically injured. Head and thoracic injuries accounted for ~61 % and ~33 % of severe injury, with ~43 % of trauma involving motor vehicle collisions.

Across provinces, only the proportion of head and abdominal injuries and the mechanisms of injury varied.

Nearly 77.6 % (2,335 children) reached a pediatric trauma center. This agrees with US figures from 2019 and 2020, showing that 73 % to 74 % of children with trauma have potential access to such centers within one hour, up from the 59 % reported in 2006. However, the corresponding figure in Canada for 2016 was only 65 %.

The increased access at present may mirror both later guidelines recommending pediatric trauma management at such centers and the development of these systems over time.

Of these 2,335 children, 879, or 29 %, were directly transported to the center. Conversely, 48.4 % (1,456 children) were first admitted to another acute care center, including adult trauma centers or hospitals without trauma designations, and then transferred to their respective trauma centers.

Over 80 % of children with trauma aged up to twelve years were admitted to trauma centers. In contrast, 70 % of children between 13 and 15 years gained access. Children with more severe injuries were more likely to access these centers, with nearly 90 % admission rates for critically injured patients.

Across the nine provinces in the study, a quarter of children with trauma did not gain access to a trauma center.

Provincial comparisons showed lower access in British Columbia, the Atlantic provinces, and Saskatchewan, with the odds being ~20-30 % lower compared to Ontario. In contrast, Alberta and Manitoba had a 6-14 % higher chance of access.

These differences in access were reflected across subgroups based on age group, mechanism of injury, and severity. They reflect US findings as well. Recent research suggests that such centers are more beneficial for younger children than for adolescents, for whom access to pediatric centers has not been consistently associated with improved mortality outcomes.

The admission rates correlated with the potential one-hour access rates and reflect the availability of such centers. For instance, compared to Ontario, which has 0.37 centers per 10,000 km, and Manitoba, with 0.38 centers per 10,000 population below 15 years of age, British Columbia has only 0.11 and 0.14 centers, respectively.

Similarly, the Atlantic provinces face logistical difficulties, with fewer than half of the children being within an hour’s drive of such a center.

Other factors are also at work, however, such as prehospital care and decision-making protocols, as well as transfers between hospitals. Again, nonpediatric hospitals may contribute to delays in definitive pediatric trauma care, particularly when pediatric readiness and transfer pathways are limited.

Improved access to pediatric trauma centers in Canada thus requires a multipronged strategy, beginning with standardized management protocols at trauma sites and nonpediatric hospitals. This would facilitate and improve trauma care, even more than investment-heavy infrastructure at the outset. A similar US guideline was published by the American College of Surgeons in 2021.

Other potentially useful steps include making all hospitals capable of rapidly triaging pediatric trauma and establishing teleconsultation hotlines to leverage the skills available at pediatric trauma centers. These have the double advantage of avoiding unnecessary transfers if a child can be managed closer to home, even at a nonpediatric center.

National databases should be set up to capture all trauma data from the whole country, with links to emergency department and hospital discharge data. This would help ensure high-quality, equitable, properly monitored care and identify areas for future investment.

Inproving access requires policy action

One in four children with trauma in Canada is treated outside a pediatric trauma care center, and this varies across provinces. Both short- and long-term policy interventions are essential to improve pediatric trauma care.

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