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Characterizing Physical Trauma In Children And Youth With Special Health Care Needs
*Denise F. Lillvis1, Karen M. Sheehan2, Jihnhee Yu3, Katia Noyes3, *Kathryn D. Bass1, Dennis Z. Kuo3
1John R. Oishei Children's Hospital, Buffalo, NY;2Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL;3University at Buffalo, Buffalo, NY

Background: Children and Youth with Special Health Care Needs (CYSHCN) have or are at an increased risk for a chronic condition that necessitates medical and related services beyond what children usually require. While evidence suggests that CYSHCN are at an increased risk of accidental injury, little is known about this population within the trauma system. This study aims to describe CYSHCN within the pediatric trauma system and to examine the relative risk of CYSHCN status with regard to trauma injury characteristics.
Methods: Using data from the 2018 National Trauma Data Bank, we identified pediatric encounters (<19 years, n=115,578) and compared demographic factors (sex, race/ethnicity, insurance status, and age) by CYSHCN status using Chi squared and t-tests. CYSHCN were compared to their non-SHCN peers using multinomial logistic regression models, controlling for patient demographic factors.
Results: Overall, 16.7% reported a SHCN such as ADD/ADHD (4.4%) or a mental/personality disorder (2.4%). CYSHCN are older, and a higher percentage reported male sex, black race, and public insurance than their non-SHCN peers (p<0.001). In multivariate models, CYSHCN encounters have a lower relative risk of unintentional injury (p<0.05) and burn trauma than other forms of trauma (p<0.05) (Table 1). CYSHCN have a higher relative risk of traumatic injury occurring in the home (p<0.01) and cut/pierce injuries (p<0.001).
Conclusions: These findings suggest that CYSHCN deserve a special focus for traumatic injury prevention.

Table 1. Association between CYSHCN status and injury and incident characteristics, pediatric encounters (2018)
CharacteristicRelative Risk RatioStd. Err.zP>|z|[95% Conf. Interval]
Intent (N = 111,934)
Unintentional(base outcome)
Self-inflicted4.2080.27122.340.0003.709 4.773
Assault1.3310.0409.470.0001.255 1.412
Undetermined1.2670.1112.700.0071.067 1.504
Other1.8630.5332.180.0301.064 3.263
Place of Injury (N = 91,442)
Private Residence(base outcome)
School0.8830.032-3.430.0010.823 0.948
Sports Facility0.5510.022-14.620.0000.509 0.597
Street/Highway0.8960.021-4.770.0000.857 0.937
Wilderness/Rec0.7390.025-8.820.0000.691 0.791
Other2.7040.26210.270.0002.237 3.270
Trauma Type (N = 111,112)
Burns(base outcome)
Blunt1.1090.0542.140.0331.009 1.219
Penetrating1.2420.0664.070.0001.119 1.379
Other/Unspecified1.7990.1387.680.0001.548 2.090
Mechanism (N = 110,367)
Cut/Pierce(base outcome)
Falls0.7280.031-7.390.0000.670 0.792
MVC0.7190.031-7.650.0000.661 0.783
Struck By/Against0.6660.031-8.720.0000.608 0.730
Firearms0.7280.039-5.930.0000.655 0.808
Other0.6870.030-8.450.0000.630 0.750
This table displays the results of four separate multinomial logistic regression models for each injury/intent characteristic. The relative risk ratios displayed pertain to the CYSHCN indicator variable. Models also controlled for sex, race/ethnicity, insurance status, and age (not shown).


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