123 - Impact of race, ethnicity, and insurance type on in-hospital death in children with traumatic injury.

Poster Number: 123
Publication Number: 123.329

Daniela Tenorio, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, san antonio, TX, United States; Karthik Rajasekaran, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Alvaro Moreira, University of Texas Health Science Center San Antonio, San Antonio, TX, United States

Background:
Pediatric trauma is the most common cause of childhood death. Previous studies in adults have shown significant racial disparity regarding patient outcomes after trauma.

Objective: Examine trauma outcomes according to insurance type and race/ethnicity in children.

Design/Methods:
In this retrospective study, we included children younger than 16 years of age from the National Data Trauma Bank (NTDB) between the years 2007 and 2015. All forms of trauma were included if the Injury Severity Score (ISS) was >9. Race/ethnicity was categorized as follows: White, Black, and Hispanic children. Our primary outcome was in-hospital mortality and other variables collected included mechanism of injury, sex, age, Glasgow coma scale (GCS), and transportation mode. Continuous variables were presented by median with interquartile range (IQR), while categorical data was described by number and percent. Wilcoxon rank sum and chi square analysis were performed accordingly using R. Significant variables on univariate analysis (p < 5%) were included on multivariate analyses.

Results:
In 190,131 US children, 38,644 were Black (20.3%), 139,735 were White (73.5%), and 11,752 were Hispanic (6.18%). The median age for the whole population was 8 years (IQR 9) and 35.4 % were females. In-hospital death occurred in 1,809 (0.95%) children. Overall, the top two mechanisms associated with death included falls (38.9%) and motor vehicle accidents (21.8%). Black children were more likely to die (1.4%) compared to White (0.8%) and Hispanic (1.0%) children. Of concern, firearm injury was considerably higher in Black children (4.7% vs 0.7% White and 1.1% Hispanic).  Although race/ethnicity was significant on univariate analysis, it did not reach importance in the logistic regression model. On the contrary, uninsured patients associated with in-hospital mortality and remained significant in the model [OR 1.92 (95% CI: 1.56, 2.37, p< 0.01)]. Risk factors that also associated with in-hospital death included age, intent, ISS, and GCS.
Conclusion(s):
Disparities based on racial origin and insurance status continue to be a challenge in our society, putting some children and adolescents at potential risk for poor outcome. Contrary to the adult literature, race/ethnicity was not a risk factor for in-hospital death; however, children without insurance were at higher risk for death.

Table 1. Demographic characteristics of US pediatric trauma patients.