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Neighborhood Characteristics Associated with Non-Accidental Trauma
Yangyang R. Yu, MD1; Annalyn S. Demello, RN 2; Charles Cox, MD3; Christopher S. Greeley, MD, MS, FAAP2; Bindi Naik-Mathuria, MD, MPH 1; David E. Wesson, MD 2
1Baylor College of Medicine, Texas Children's Hospital, Houston, TX; 2Texas Children's Hospital, Houston, TX; 3University of Texas Health Science Center at Houston Dept of Pediatric Surgery, Houston, TX

Background: Non-accidental trauma (NAT) represents a significant proportion of pediatric traumas. We sought to assess the impact of neighborhood characteristics on NAT incidence.

Methods: Trauma registry data from two level 1 pediatric trauma centers serving a large metropolitan area were used to identify NAT victims under age 5 during 2011 through 2015 and their zipcode of residence. Incidence of NAT admissions and NAT fatalities per 10,000 population were compared by neighborhood income and education status using Mann-Whitney U analysis.

Results: Overall, there were 557 NAT admissions (42 fatalities, 7.5%). The majority (96%, n=535) of our NAT population reside in 2 out of 22 trauma service areas within our state, representing 173 zipcodes. Neighborhoods of lower income status (<$61,465 median income) had significantly higher incidence of NAT admissions(13.5 vs 7.8, p<0.001) and NAT fatalities(5.4 vs 2.3, p<0.001). Zipcodes with lower percentage of population completing high school and lower percentage completing a 4-year college program had significantly higher incidence of NAT admissions(13 vs 9, p<0.001; 13 vs 8, p<0.001, respectively). However, there was no association between lower education rates and incidence of NAT fatalities(high school:5 vs 4, p=0.16, college:5 vs 3, p=0.09). Areas of increased NAT incidences are shown in a heatmap(Figure 1).

Conclusions: Lower income and lower education neighborhoods have higher incidence of NAT admissions. Mapping these areas may be helpful to target prevention efforts.

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