Severity, Access, and Process as Bases for Outcomes Disparities in Pediatric Traumatic Brain Injury
Joseph Piatt, MD, MAS1; Zachary Gandee2
1Nemours / A I duPont Hospital for Children, Wilmington, DE; 2Thomas Jefferson University, Philadelphia, PA
Racial and economic disparities in health outcomes are demonstrated consistently in the United States for various medical and surgical conditions including trauma. Whether differences arise from disease severity, access to care, or processes of care is mostly obscure.
Data were acquired from the Trauma Quality Improvement Program of the American College of Surgeons for 2014 – 2016. All cases were 18 years or younger. Severe traumatic brain injury (sTBI) was defined by a valid GCS score 8 were excluded. White, non-Hispanic children were compared with all others, as were children with public insurance or none.
There were 3252 cases of sTBI. Overall mortality was 15.5%. Non-white children were at greater risk of death (OR 1.19, CI 0.98 – 1.44), as were children with public insurance (OR 1.38, CI 1.13 – 1.68). Non-white children and children with public insurance were younger. Abuse was associated with public insurance. Penetrating mechanism had no association with race or insurance. Both race and insurance status had many significant associations with access factors. Non-white children spent more time in emergency departments, but EMS response time and time at the scene were longer for white children. There were no other associations with processes of care.
Race and economic status have consistent associations with access to care. How differences in disease severity, access, and processes of care relate to outcomes will be analyzed in multivariate models.
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