Disparities in child abuse mortality are not explained by injury severity

Falcone, Richard A.; Brown, Rebeccah L.; Garcia, Victor F.

doi:10.1016/j.jpedsurg.2007.01.038

Cited by 36 publications

(21 citation statements)

References 36 publications

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“…As many previous investigations have shown, race has a significant association with mortality rates from trauma, 5,7,[14][15][16]18,20,31,32,41 although not all studies affirm this association. 19,23,42 Racial disparities in outcomes after childhood trauma have been reviewed recently.…”

Section: Mortality Ratesmentioning

confidence: 85%

Hospital care of childhood traumatic brain injury in the United States, 1997–2009: a neurosurgical perspective

Piatt

Neff

2012

PED

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Object The goal in this paper was to study hospital care for childhood traumatic brain injury (TBI) in a nationwide population base. Methods Data were acquired from the Kids' Inpatient Database (KID) for the years 1997, 2000, 2003, 2006, and 2009. Admission for TBI was defined by any ICD-9-CM diagnostic code for TBI. Admission for severe TBI was defined by a principal diagnostic code for TBI and a procedural code for mechanical ventilation; admissions ending in discharge home alive in less than 4 days were excluded. Results Estimated raw and population-based rates of admission for all TBI, for severe TBI, for death from severe TBI, and for major and minor neurosurgical procedures fell steadily during the study period. Median hospital charges for severe TBI rose steadily, even after adjustment for inflation, but estimated nationwide hospital charges were stable. Among 14,932 actual admissions for severe TBI captured in the KID, case mortality was stable through the study period, at 23.9%. In a multivariate analysis, commercial insurance (OR 0.86, CI 0.77–0.95; p = 0.004) and white race (OR 0.78, CI 0.70–0.87; p < 0.0005) were associated with lower mortality rates, but there was no association between these factors and commitment of resources, as measured by hospital charges or rates of major procedures. Increasing median income of home ZIP code was associated with higher hospital charges and higher rates of major and minor procedures. Only 46.8% of admissions for severe TBI were coded for a neurosurgical procedure of any kind. Fewer admissions were coded for minor neurosurgical procedures than anticipated, and the state-by-state variance in rates of minor procedures was twice as great as for major procedures. Possible explanations for the “missing ICP monitors” are discussed. Conclusions Childhood brain trauma is a shrinking sector of neurosurgical hospital practice. Racial and economic disparities in mortality rates were confirmed in this study, but they were not explained by available metrics of resource commitment. Vigilance is required to continue to supply neurosurgical expertise to the multidisciplinary care process.

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Section: Mortality Ratesmentioning

confidence: 85%

Hospital care of childhood traumatic brain injury in the United States, 1997–2009: a neurosurgical perspective

Piatt

Neff

2012

PED

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“…African-American infants had higher mortality rates from all mechanisms of injury, even after accounting for insurance coverage. 13 In a follow-up study, this group analyzed mortality rates from abusive head injury in infancy. 35 The investigators controlled for severity of injury by means of a CT scan grading system in addition to ISS and GCS scores.…”

Section: Discussionmentioning

confidence: 99%

Pediatric spinal injury in the US: epidemiology and disparities

Piatt¹

2015

PED

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OBJECT In the US, race and economic status have pervasive associations with mechanisms of injury, severity of injury, management, and outcomes of trauma. The goal of the current study was to examine these relationships on a large scale in the setting of pediatric spinal injury. METHODS Admissions for spinal fracture without or with spinal cord injury (SCI), spinal dislocation, and SCI without radiographic abnormality were identified in the Kids’ Inpatient Database (KID) and the National Trauma Data Bank (NTDB) registry for 2009. Patients ranged in age from birth up to 21 years. Data from the KID were used to estimate nationwide annual incidences. Data from the NTDB were used to describe patterns of injury in relation to age, race, and payor, with corroboration from the KID. Multiple logistic regression was used to model rates of mortality and spinal fusion. RESULTS In 2009, the estimated incidence of hospital admission for spinal injury in the US was 170 per 1 million in the population under 21 years of age. The incidence of SCI was 24 per 1 million. Incidences varied regionally. Adolescents predominated. Patterns of injury varied by age, race, and payor. Black patients were more severely injured than patients of other races as measured by Injury Severity Scale scores. Among black patients with spinal injury in the NTDB, 23.9% suffered firearm injuries; only 1% of white patients suffered firearm injuries. The overall mortality rate in the NTDB was 3.9%. In a multivariate analysis that included a large panel of clinical and nonclinical factors, black race retained significance as a predictor of mortality (p = 0.006; adjusted OR 1.571 [1.141–2.163]). Rates of spinal fusion were associated with race and payor in the NTDB data and with payor in the KID: patients with better insurance underwent spinal fusion at higher rates. CONCLUSIONS The epidemiology of pediatric spinal injury in the US cannot be understood apart from considerations of race and economic status.

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“…13 Similar to our qualitative review, our meta-analysis demonstrates that black patients have worse trauma mortality rates than white patients. Of the 24 studies in the qualitative analysis, 14 were eligible for meta-analysis, 20,[22][23][24][25][27][28][29][30][31][32][34][35][36] one study was eliminated from the analysis because it did not provide data for specific races. 31 Another study was eliminated because it did not provide ORs comparing minority races to the reference group.…”

Section: Disparities By Racementioning

confidence: 99%

“…Most prominent are well-documented racial disparities in pediatric TBI patients. 34,35 In a retrospective study comparing 3,111 pediatric head injury patients from the trauma database of Cincinnati Children's Hospital Medical Center (CCHMC) to 13,363 patients in the National Trauma Database, Falcone et al 34 found that, even after controlling for insurance, injury severity, and other factors, African-American children had a mortality odds ratio 3.1 times higher than that of white children (95% CI 1.2-7.8). In moderately and severely injured pediatric trauma patients in the NTDB, blacks had higher mortality rates than whites (OR 1.37, 95% CI 1.22-1.52), even after controlling for insurance status, injury severity, and other factors.…”

Section: Disparities By Racementioning

confidence: 99%

“…The overwhelming majority of data show that black race is a predictor of higher trauma mortality independent of SES. Of the eight studies that compared black and white trauma patients while controlling for insurance status, seven 14,[25][26][27][32][33][34] showed that black race is an independent predictor of mortality while one study 5 found no significant difference. Arthur et al 23 conclude that black patients have higher mortality rates independent of both proxies for SES (insurance status and median income of patient zip code).…”

Section: Independence Of Race Outcome Disparitiesmentioning

confidence: 99%

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