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Disparities In Rural And Urban Pediatric Trauma Outcomes: A State-wide Retrospective Cohort Study
*Caroline Q Stephens1, David P Lehrfeld2, Elizabeth Dewey3, *Nicholas A. Hamilton3, Craig Newgard3, *Sanjay Krishnaswami3
1University of California- San Francisco, San Francisco, CA;2Oregon Health Authority, Portland, OR;3Oregon Health and Science University, Portland, OR

Background:
Rural children experience disparities in access to pediatric trauma care[1,2], however, the potential inequities in outcomes for all types of trauma remain largely uncharacterized. We hypothesized that rural children may experience greater trauma-related morbidity and mortality in our state. Methods:
We conducted a retrospective cohort study of all pediatric(≤15 years) trauma activations (2013-2016) using our state trauma registry, with rurality defined by injury location. A propensity-score matched(PSM) cohort was created, using age, race, comorbidity, injury type, and insurance. Outcomes were compared in the entire cohort and the PSM cohort. Statistical significance was p<0.05. Findings:
Between 2013-2016, 4,263 children were injured, and 3,583 met inclusion criteria (78% Urban, 22% Rural). Rural children were more often involved in motor(p=0.002) and recreational vehicle crashes(p≤0.001), but no differences were found in injury severity(p=0.18). Rural children were significantly more likely to be initially managed by Level 3/4 and non-trauma hospitals(90% vs. 28%, p≤0.001), and subsequently admitted and transferred(Table). However, no differences were found in mortality(p=0.26), need for major surgery(p=0.21), or ICU care(p=0.42). Conclusions:
Despite significant differences in injury mechanism and presenting hospital trauma level, we found no disparities in outcomes between urban and rural children. These findings support efforts to create regionalized systems of care with management of appropriate children locally, while maximizing efficiency for children who require higher-level care, and minimizing over-triage and unnecessary costs.

Urban vs. Rural Pediatric Trauma Outcomes (*p<0.001)
OutcomesUrban (Entire Cohort)N=2,786Rural (Entire Cohort) N=797Urban (PSM Cohort)N=778Rural (PSM Cohort)N=778
Hospital Admission, n (%)1045 (38%)*353 (44%)*316 (41%)343 (44%)
Hospital Transfer, n (%)927 (33%)*341 (43%)*237 (31%)*334 (43%)*
Mortality, n (%)48 (2%)13 (2%)11 (1%)12 (2%)
Major Surgery, n (%)355 (13%)87 (11%)100 (13%)84 (11%)


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