Pediatric Injury Outcomes in Racial/Ethnic Minorities in California

Ramírez, Michelle; Chang, David C.; Bickler, Stephen W.

doi:10.1001/2013.jamasurg.3

Cited by 23 publications

(13 citation statements)

References 15 publications

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“…There is general agreement that economic status, as measured by insurance coverage or median income of home zip code, is associated with mortality rates. 45,46,55,56 Absence of insurance coverage, so-called "self-pay" status, is a particularly adverse factor. 24,43,55,56 In the pediatric age range, however, trauma patients admitted without insurance often acquire retroactive Medicaid coverage, and this coverage is registered in discharge data if the hospital stay is long enough.…”

Section: Discussionmentioning

confidence: 99%

“…43 Conflicting findings in other reports raise the possibility of geographic inhomogeneity in the importance of race as a predictor of pediatric trauma mortality. 28,45 Little is known about disparities in functional outcomes in childhood trauma, but in an analysis of data from the National Pediatric Trauma Registry, after adjustment for severity and mechanism, Haider et al found that black children with TBI were discharged from the hospital with greater degrees of disability, as measured by the WeeFIM (Functional Independence Measure for children).…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pediatric spinal injury in the US: epidemiology and disparities

Piatt¹

2015

PED

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“…23 While not developed for use in pediatric populations, this index has been widely used, including in the evaluation of children. 24,25 Additionally, we adjusted for concomitant infection using a composite outcome created from the most common infections described in prior studies of immunosuppressed patients with IBD and autoimmune disorders. 26–28 We also evaluated hospital teaching status and IBD-related hospital volume.…”

Section: Methodsmentioning

confidence: 99%

Minority Pediatric Patients with Inflammatory Bowel Disease Demonstrate an Increased Length of Stay

Barnes¹,

Kochar²,

Long³

et al. 2017

Inflammatory Bowel Diseases

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Background Genetic and other biological factors may lead to differences in disease behavior among children with inflammatory bowel disease from different races, which may be further modified by disparities in care delivery. Using the Kids' Inpatient Database (KID), we aimed to evaluate differences in the management of pediatric patients with IBD by race, focusing on length of stay. Methods We performed a cross-sectional analysis using 2000-2012 data from KID, a nationally representative database. We identified pediatric patients (< 18 years of age) with discharge diagnoses of Crohn's disease (CD) or ulcerative colitis (UC). We used multivariable logistic regression to evaluate the relationship between race and length of stay (LOS), controlling for age, payer status need for surgery, and year of admission. Results We identified 27,295 hospitalizations for children with IBD (62% CD and 38% UC), Compared to white patients with CD, black [adjusted odds ratio (aOR) 1.37, 95% CI:1.22–1.53, p<0.001) and Hispanic patients (aOR 1.37, 95%CI:1.19–1.59, p<0.001) with CD demonstrated increased odds of a LOS greater than the 75th percentile. When compared to white patients with UC, Hispanic patients also demonstrated increased odds of a LOS greater than the 75th percentile (aOR 1.20, 95% CI:1.02–1.42, p=0.015). Conclusions After controlling for age, year of admission, and clinical phenotypes, black and Hispanic patients with CD and Hispanic patients with UC had longer LOS than white patients. These may be due to differences in provider/hospital characteristics, socioeconomic differences, and/or differences in genetics and other biological factors.

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“…1 We performed a subgroup analysis of visits with injuries; these visits were identified as having a diagnosis of injury based on the ICD-9-CM Tabular Index code grouping for injury, including codes between 800 and 957.9. 15 We did not use the NHAMCS survey item inquiring about injury because it defines a broader group of visits, including injuries, poisonings, and adverse effects of medical treatments.…”

Section: Study Populationmentioning

confidence: 99%

National Patterns of Codeine Prescriptions for Children in the Emergency Department

et al. 2014

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BACKGROUND AND OBJECTIVES: National guidelines have recommended against codeine use in children, but little is known about prescribing patterns in the United States. Our objectives were to assess changes over time in pediatric codeine prescription rates in emergency departments nationally and to determine factors associated with codeine prescription. METHODS: We performed a serial cross-sectional analysis (2001–2010) of emergency department visits for patients ages 3 to 17 years in the nationally representative National Hospital Ambulatory Medical Care Survey. We determined survey-weighted annual rates of codeine prescriptions and tested for linear trends over time. We used multivariate logistic regression to identify characteristics associated with codeine prescription and interrupted time-series analysis to assess changes in prescriptions for upper respiratory infection (URI) or cough associated with two 2006 national guidelines recommending against its use for these indications. RESULTS: The proportion of visits (N = 189 million) with codeine prescription decreased from 3.7% to 2.9% during the study period (P = .008). Odds of codeine prescription were higher for children ages 8 to 12 years (odds ratio [OR], 1.42; 95% confidence interval [1.21–1.67]) and among providers outside the northeast. Odds were lower for children who were non-Hispanic black (OR, 0.67 [0.56–0.8]) or with Medicaid (OR, 0.84 [0.71–0.98]). The 2006 guidelines were not associated with a decline in codeine prescriptions for cough or URI visits. CONCLUSIONS: Although there was a small decline in codeine prescription over 10 years, use for cough or URI did not decline after national guidelines recommending against its use. More effective interventions are needed to prevent codeine prescription to children.

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Pediatric Injury Outcomes in Racial/Ethnic Minorities in California

Cited by 23 publications

References 15 publications

Pediatric spinal injury in the US: epidemiology and disparities

Pediatric spinal injury in the US: epidemiology and disparities

Minority Pediatric Patients with Inflammatory Bowel Disease Demonstrate an Increased Length of Stay

National Patterns of Codeine Prescriptions for Children in the Emergency Department

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