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

Abstract

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.

Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study

“…Differential quality of healthcare based on patient race is a well described pervasive flaw in our healthcare system (21). However, there are few studies investigating differences in the risk of pediatric critical illness or in PICU utilization based on race (22)(23)(24). There are numerous studies describing racial/ethnic disparities in neonatal intensive care.…”

Child Opportunity Index and Hospital Utilization in Children With Traumatic Brain Injury Admitted to the PICU

“…Our methodology precludes identifying why this relationship exists. Differences in neighborhood condition leading to differences in injury severity and differential access to critical care services could contribute to the results seen in this study ( 24 , 25 ).…”

Procalcitonin and blood lactate level as predictive biomarkers in pediatric multiple trauma patients’ pediatric intensive care outcomes: A retrospective observational study

“…[1][2][3] There are various causes of trauma, ranging from falls to traffic accidents, burns, and other accidental injuries. [4,5] Despite advancements in injury care and prevention strategies, the risk of accidents remains a serious threat to children health and quality of life. [6] Severe pediatric trauma cases often require admission to the intensive care unit (ICU), where patients can receive specialized care and continuous monitoring.…”

“…[ 1 – 3 ] There are various causes of trauma, ranging from falls to traffic accidents, burns, and other accidental injuries. [ 4 , 5 ]…”