Association Between Insurance and Transfer of Injured Children From Emergency Departments

Huang, Yaoguo; Kissee, Jamie L.; Dayal, Parul; Wang, Nancy Ewen; Sigal, Ilana; Marcin, James P.

doi:10.1542/peds.2016-3640

Cited by 14 publications

(9 citation statements)

References 34 publications

(29 reference statements)

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“…Other studies have demonstrated that private insurance and lack of insurance have been associated with undertriage 16 17. We add nuance with our analyses in considering private HMO and private non-HMO insurances separately.…”

Section: Discussionmentioning

confidence: 99%

Patient, hospital and regional characteristics associated with undertriage of injured children in California (2005–2015): a retrospective cohort study

Wang

Newton

Spain

et al. 2019

Trauma Surg Acute Care Open

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Background/objectiveTrauma centers save lives, but they are scarce and concentrated in urban settings. The population of severely injured children in California who do not receive trauma center care (undertriage) is not well understood.MethodsRetrospective observational study of all children (0–17 years) hospitalized for severe trauma in California (2005–2015). We used the California Office of Statewide Health Planning and Development linked Emergency Department and Inpatient Discharge data sets. Logistic regression models were created to analyze characteristics associated with undertriage. The model was clustered on differential distance between distance from residence to primary triage hospital and distance from residence to nearest trauma center. We controlled for body part injured, injury type, intent and year. The a priori hypothesis was that uninsured and publicly insured children and hospitals and regions with limited resources would be associated with undertriage.ResultsTwelve percent (1866/15 656) of children with severe injury experienced undertriage. Children aged >14 years compared with 0–13 years had more than 2.5 times the odds of undertriage (OR 2.58; 95% CI 2.1 to 3.16). Children with private Health Maintenance Organization (HMO) insurance compared with public insurance had 13 times the odds of undertriage (OR 12.62; 95% CI 8.95 to 17.79). Hospitals with >400 compared with <200 beds had more than three times the odds of undertriage (OR 3.64; 95% CI 2.6 to 5.11). Urban versus suburban residence had 1.3 times increased odds of undertriage (OR 1.31; 95% CI 1.02 to 1.67) Undertriage volume was largest in urban areas.ConclusionUndertriage is associated with private HMO insurance, primary triage to large hospitals and urban residence. Understanding the characteristics associated with undertriage can help improve trauma systems.Level of evidenceLevel III (non-experimental retrospective observational study).

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Section: Discussionmentioning

confidence: 99%

Patient, hospital and regional characteristics associated with undertriage of injured children in California (2005–2015): a retrospective cohort study

Wang

Newton

Spain

et al. 2019

Trauma Surg Acute Care Open

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“…The majority of our patient population were transferred from an outside facility and accounted for most of the injuries seen, admissions, and discharges. One prior study found that EDs with a larger proportion of Medicaid patients had a higher odds of transferring patients with Medicaid over private payer (Huang et al, 2017). Of the remaining 30% of children in the GCTR database that were not transferred to CHOA for care, the majority received care at either an adult level 1 or level 2 trauma center.…”

Section: Discussionmentioning

confidence: 99%

Pediatric falls ages 0–4: understanding demographics, mechanisms, and injury severities

et al. 2018

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BackgroundPediatric unintentional falls are the leading cause of injury-related emergency visits for children < 5 years old. The purpose of this study was to identify population characteristics, injury mechanisms, and injury severities and patterns among children < 5 years to better inform age-appropriate falls prevention strategies.MethodsThis retrospective database study used trauma registry data from the lead pediatric trauma system in Georgia. Data were analyzed for all patients < 5 years with an international classification of disease, 9th revision, clinical modification (ICD-9 CM) external cause of injury code (E-code) for unintentional falls between 1/1/2013 and 12/31/2015. Age (months) was compared across categories of demographic variables, injury mechanisms, and emergency department (ED) disposition using Kruskal-Wallis ANOVA and the Mann Whitney U test. The relationships between demographic variables, mechanism of injury (MOI), and Injury Severity Score (ISS) were evaluated using multinomial logistic regression.ResultsInclusion criteria were met by 1086 patients (median age = 28 months; 59.7% male; 53.8% White; 49.1% < 1 m fall height). Younger children, < 1-year-old, primarily fell from caregiver’s arms, bed, or furniture, while older children sustained more falls from furniture and playgrounds. Children who fell from playground equipment were older (median = 49 months, p < 0.01) than those who fell from the bed (median = 10 months), stairs (median = 18 months), or furniture (median = 19 months). Children < 1 year had the highest proportion of head injuries including skull fracture (63.1%) and intracranial hemorrhage (65.5%), 2-year-old children had the highest proportion of femur fractures (32.9%), and 4-year-old children had the highest proportion of humerus fractures (41.0%). Medicaid patients were younger (median = 24.5 months, p < 0.01) than private payer (median = 34 months). Black patients were younger (median = 20.5 months, p < 0.001) than White patients (median = 29 months). Results from multinomial logistic regression models suggest that as age increases, odds of a severe ISS (16–25) decreased (OR = 0.95, CI = 0.93–0.97).ConclusionsPediatric unintentional falls are a significant burden of injury for children < 5 years. Future work will use these risk and injury profiles to inform current safety recommendations and develop evidence-based interventions for parents/caregivers and pediatric providers.Electronic supplementary materialThe online version of this article (10.1186/s40621-018-0147-x) contains supplementary material, which is available to authorized users.

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“…(Delgado et al, 2014 ) In a similarly designed pediatric study including more than 9000 traumatically injured children, those with public insurance had a higher odds of transfer to a dedicated trauma center from a referral hospital when compared to children with private insurance (odds ratio [OR]: 1.3; 95% CI: 1.0–1.5). (Huang et al, 2017 ) These studies suggest that non-clinical factors, including attempts to minimize revenue losses from treating underinsured patients, may influence triage decisions. (Delgado et al, 2014 ; Huang et al, 2017 )…”

Section: Discussionmentioning

confidence: 99%

“…(Huang et al, 2017 ) These studies suggest that non-clinical factors, including attempts to minimize revenue losses from treating underinsured patients, may influence triage decisions. (Delgado et al, 2014 ; Huang et al, 2017 )…”

Section: Discussionmentioning

confidence: 99%

US children of minority race are less likely to be admitted to the pediatric intensive care unit after traumatic injury, a retrospective analysis of a single pediatric trauma center

2021

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Background The public health impact of pediatric trauma makes identifying opportunities to equalize health related disparities imperative. The influence of a child’s race on the likelihood of admission to the pediatric intensive care unit (PICU) is not well described. We hypothesized that traumatically injured children of minority race would have higher rates of PICU admission, compared to White children. Methods This was a retrospective review of a single institution’s trauma registry including children ≤18 years of age presenting to the emergency department (ED) whose injury necessitated pediatric trauma team activation at a Level 1 Pediatric Trauma Center from July 1, 2011 through June 30, 2016. Demographics, injury characteristics and hospital utilization data were collected. Race was categorized as White or racial minority, which included patients identifying as Black, Hispanic ethnicity, Native American or “other.” The primary outcome measure was admission to the PICU. Chi square or Mann Whitney rank sum tests were used, as appropriate, to compare differences in demographics and injury characteristics between those children who were and were not admitted to the PICU setting. Variables associated with PICU admission in univariate analyses were included in a multivariate analysis. Data are presented as median values and interquartile ranges, or numbers and percentages. Results The median age of the 654 included subjects was 8 [IQR 4–13] years; 55.2% were a racial minority. Nine (1.4%) children died in the ED and 576 (88.1%) were admitted to the hospital. Of the children requiring hospitalization, 195 (33.9%) were admitted to the PICU. Children admitted to the PICU were less likely to be from a racial minority group (26.1% vs 42.5%, p < 0.001). After adjusting for age and injury characteristics in a multivariable analysis, racial minority children had a lower odds of PICU admission compared to White children (OR 0.492 [95% C.I. 0.298–0.813, p = 0.006]). Conclusions In this retrospective analysis of traumatically injured children, minority race was associated with lower odds of PICU admission, suggesting that health care disparities based on race persist in pediatric trauma-related care.

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Association Between Insurance and Transfer of Injured Children From Emergency Departments

Cited by 14 publications

References 34 publications

Patient, hospital and regional characteristics associated with undertriage of injured children in California (2005–2015): a retrospective cohort study

Patient, hospital and regional characteristics associated with undertriage of injured children in California (2005–2015): a retrospective cohort study

Pediatric falls ages 0–4: understanding demographics, mechanisms, and injury severities

US children of minority race are less likely to be admitted to the pediatric intensive care unit after traumatic injury, a retrospective analysis of a single pediatric trauma center

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