Disparities In Isolated, Serious, Blunt Splenic Injury Outcomes For Pediatric Patients
Whitney Orji, Robert Swendiman, Nicolas Muñoz, Myron Allukian, III, *Gary Nace, *Michael Nance
University of Pennsylvania, Philadelphia, PA
Background: Healthcare disparities are pervasive in medicine and surgery.1,2 We aimed to characterize disparities that may exist in the care of pediatric patients with blunt splenic injuries.
Methods: The Trauma Quality Improvement Program data set (2016-2018) was queried for patients ≤18 years who sustained a serious, blunt splenic injury (AIS ≥3) with no other serious injury (AIS >2). Patient demographics, injury characteristics, and outcomes were summarized, and multivariable logistic regression was used to determine their association with splenectomy, angiography, and a combined intervention outcome.
Findings: From 2016-2018, 2,253 children were treated for an isolated blunt splenic injury at a high-level trauma center (Level I or II). The cohort was predominantly white (79.7%) and privately insured (62.3%). The median injury severity score (ISS) was 14 (IQR 9-17). Less than 2% of patients underwent angiography and 6% underwent splenectomy. Increasing age, injury severity, and length of stay conferred greater odds of intervention. Neither race, ethnicity, nor insurance type were significantly associated with odds of intervention. Treatment at a pediatric or combined trauma center was associated with lower odds of intervention.
Conclusions: In this cohort of patients with a common pediatric injury, there was no racial or insurance-based disparity in rates of intervention. This may be due in part to the protocolized nature of care for splenic injuries. Future work should account for the cohort’s relative homogeneity.
|Odds of splenectomy||Odds of angiography||Odds of either intervention||Odds of either intervention|
|Age||1.167 [1.09,1.25]*||1.100 [0.99,1.23]||1.151 [1.09,1.22]*||1.151 [1.09,1.22]*|
|Race (Black v white)||0.586 [0.20,1.73]||0.548 [0.07,4.18]||0.529 [0.20,1.41]||0.529 [0.20,1.41]|
|Ethnicity (Hispanic/Latino v not)||1.213 [0.65,2.25]||2.442 [0.91,6.58]||1.351 [0.76,2.39]||1.351 [0.76,2.39]|
|Payer (private v public)||0.757 [0.47,1.22]||1.641 [0.64,4.23]||0.926 [0.60,1.44]||0.926 [0.60,1.44]|
|Trauma center type (pediatric v adult)||0.112 [0.04,0.32]*||0.483 [0.15,1.53]||0.158 [0.07,0.34]*||0.158 [0.07,0.34]*|
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