Driving Time to Trauma Centers for Children Living in Wisconsin.

INTRODUCTION: Trauma is the number 1 cause of death among children. Shorter distance to definitive trauma care has been correlated with better clinical outcomes. There are only a small number of pediatric trauma centers (PTC) designated by the American College of Surgeons, and the resources available to treat injured children at non-PTCs are limited. To guide resource allocation and advocacy efforts for pediatric trauma care in Wisconsin, we determined the precise distance to trauma centers for all children living in the state. METHODS: The 2010 US Census data was used to determine ZIP-centroid geolocation. The Wisconsin Department of Health Services trauma classification database was used to identify trauma facilities in Wisconsin. SAS routines invoking the Google Maps application programming interface were used to calculate the driving distance to each of the trauma facilities. We quantified the percentage of children living within 30- and 60-minute driving distances of level I-IV trauma centers. RESULTS: Just 31.3% of Wisconsin children live within a 30-minute drive of a level I PTC; 32.7% live within 30 minutes of a level II center; 81.3% within 30 minutes of a level III center; and 74.6% within 30 minutes of a level IV center. CONCLUSION: Two-thirds of children in Wisconsin live beyond a 30-minute driving distance of a level I PTC, but most children live within 30 minutes of level III and IV trauma centers. As the closest hospitals for most children, smaller trauma centers should be adequately resourced to provide pediatric trauma care.

Damp mouldy housing and early childhood hospital admissions for acute respiratory infection: a case control study.

INTRODUCTION: A gap exists in the literature regarding dose-response associations of objectively assessed housing quality measures, particularly dampness and mould, with hospitalisation for acute respiratory infection (ARI) among children. METHODS: A prospective, unmatched case-control study was conducted in two paediatric wards and five general practice clinics in Wellington, New Zealand, over winter/spring 2011-2013. Children aged <2 years who were hospitalised for ARI (cases), and either seen in general practice with ARI not requiring admission or for routine immunisation (controls) were included in the study. Objective housing quality was assessed by independent building assessors, with the assessors blinded to outcome status, using the Respiratory Hazard Index (RHI), a 13-item scale of household quality factors, including an 8-item damp-mould subscale. The main outcome was case-control status. Adjusted ORs (aORs) of the association of housing quality measures with case-control status were estimated, along with the population attributable risk of eliminating dampness-mould on hospitalisation for ARI among New Zealand children. RESULTS: 188 cases and 454 controls were studied. Higher levels of RHI were associated with elevated odds of hospitalisation (OR 1.11/unit increase (95% CI 1.01 to 1.21)), which weakened after adjustment for season, housing tenure, socioeconomic status and crowding (aOR 1.04/unit increase (95% CI 0.94 to 1.15)). The damp-mould index had a significant, adjusted dose-response relationship with ARI admission (aOR 1.15/unit increase (95% CI 1.02 to 1.30)). By addressing these harmful housing exposures, the rate of admission for ARI would be reduced by 19% or 1700 fewer admissions annually. CONCLUSIONS: A dose-response relationship exists between housing quality measures, particularly dampness-mould, and young children's ARI hospitalisation rates. Initiatives to improve housing quality and to reduce dampness-mould would have a large impact on ARI hospitalisation.

Indoor allergen exposure in primary school classrooms in New Zealand.

AIM: Indoor allergens exposure is a risk factor for respiratory symptoms in sensitised children. There is limited data on indoor allergen exposures in New Zealand schools. METHODS: Vacuumed floor dust samples were collected from 136 classrooms in 12 primary schools and analysed for allergens from the house dust mite Dermatophagoides pteronyssinus (Der p 1), cat dander (Fel d 1), cockroach (Bla g 2), cow dander (Bos d 2), horse dander (Equ c 4) and peanut (Ara h 2) by ELISA. RESULTS: House dust mite, cat, cockroach, cow and horse allergens were detected in 96.4%, 100%, 2.2%, 27.0% and 59.9% respectively in the classrooms dust samples. Thirty-one (22.6%) classrooms had Fel d 1 levels of >8.0µg/g while none had Der p 1 levels of >10.0µg/g. Only one classroom had detectable levels of peanut allergen. CONCLUSIONS: House dust mite allergen levels were low in New Zealand classrooms while about a quarter of classrooms had cat allergen levels that may be associated with respiratory symptoms.