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Racial Disparities in Pediatric Trauma Outcomes: Does Site of Care make a Difference?
Meesha Sharma, MD, MPH1, Lindsey L. Wolf, MD1, John W. Scott, MD, MPH1, Juan P Herrera-Escobar, MD1, Tolulope A. Oyetunji, MD, MPH2, Ali Salim, MD1,3, Adil Haider, MD, MPH, FACS1. 1Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA, 2Children's Mercy Hospitals and Clinics, Kansas City, MO, USA, 3Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA.

Background: Racial disparities in pediatric trauma outcomes have been previously documented. Better outcomes have been demonstrated among children treated at pediatric (PTC) versus adult (ATC) trauma centers. We sought to determine the impact of treatment site on race-based disparities in trauma outcomes.

Methods: We abstracted data from 2007-2012 National Trauma Data Bank, including children <18y admitted to an ACS-verified level I/II ATC or I/II PTC with Injury Severity Score (ISS) ≥9, excluding trauma centers with both adult and pediatric verification. We used multivariable logistic regression (covariates: age, sex, insurance status, mechanism of injury, ISS, physiological severity, hospital region, hospital size, teaching status) to assess race-associated odds of mortality at PTCs and ATCs.

Results: We included 112,610 children. Overall, 4.33% children died (3.41% non-Hispanic white, 7.71% non-Hispanic black, 4.92% Hispanic (p<0.001)). Mortality was higher at ATCs (5.09% versus 2.44% at PTCs (p<0.001)). After risk adjustment, odds of death were 33% greater at ATCs than PTCs, and black children had 35% greater odds of death than white children; no difference was seen between Hispanic and white children. On stratification, black race was significantly associated with increased mortality at ATCs (Table).

Conclusions: Racial disparities in pediatric trauma outcomes may be driven, in part, by disparities at ATCs. Further research is required to determine which characteristics of ATCs may contribute to these disparities in order to address them.

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