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According to the federal Emergency Medical Treatment and Active Labor Act (EMTALA), all hospitals are required to treat patients until they are medically stable, regardless of insurance status. "We have this idea that everyone is treated equally, yet the mortality rate after trauma among uninsured children is much higher when compared to children with commercial insurance," says Rosen.

The study, involving researchers from Children's, Escuela de Medicina de Harvard, y Hospital Brigham y Women's Hospital, collected and analyzed data from the National Trauma Data Bank, a consortium of more than 900 trauma centers across the country.

The researchers examined data from 174,921 trauma patients aged 17 years and younger. Patients were divided into three groups: uninsured, publicly insured, and commercially insured.

After adjusting for factors such as race, age, gender, injury type and injury severity, results showed that uninsured trauma patients were over three times more likely to die after trauma than patients who were commercially insured by plans such as Blue Cross/Blue Shield and worker's compensation. Furthermore, patients with public insurance, including Medicaid and the State Children's Health Insurance Program (SCHIP), were 1.19 times more likely to die than commercially insured patients.

The researchers speculate about several possible explanations for their findings. One is that trauma patients with public insurance or no insurance may be transferred from one hospital to another, causing a delay in definitive treatment. Uninsured patients may also undergo fewer medical tests, leading to inadequate diagnoses or missed injuries. In addition, if uninsured patients do not speak English as their first language or are less educated overall, they may be less able to communicate with medical providers about their medical history and quality of care after sustaining an injury.

"This study suggests that there may be a direct effect of possessing insurance. We need to work harder to get to the point where every person has access to health care in this country," Rosen says.

Because emergency trauma treatment should theoretically begin before providers know a patient's insurance status, researchers insist that further investigation is needed to determine why these health disparities exist. For the future, Rosen would like to conduct a prospective study of the processes involved in pediatric trauma care according to insurance status, looking at differences in quality of care in real time.

La article, "Lack of Insurance Negatively Affects Trauma Mortality in U.S. Children," is published in the October issue of the Journal of Pediatric Surgery.

Founded in 1869 as a 20-bed hospital for children, Children's Hospital Boston today is one of the nation's leading pediatric medical centers, the primary pediatric teaching hospital of Harvard Medical School, and the largest provider of health care to Massachusetts children. In addition to 396 pediatric and adolescent inpatient beds and more than 100 outpatient programs, Children's houses the world's largest research enterprise based at a pediatric medical center, where its discoveries benefit both children and adults. More than 500 scientists, including eight members of the National Academy of Sciences, 11 members of the Institute of Medicine and 13 members of the Howard Hughes Medical Institute comprise Children's research community. For more information about the hospital visit: www.childrenshospital.org/newsroom.