An investigation of social determinants of health and outcomes in pediatric nonaccidental trauma

Ruth Ellen Jones, Jacqueline Babb, Kristin M. Gee, Alana L Beres

Research output: Contribution to journalArticle

Abstract

Objectives: Nonaccidental trauma (NAT) is a leading cause of pediatric mortality and disability. We examined our institution’s experience with NAT to determine if socioeconomic status is correlated with patient outcomes. Methods: NAT cases were reviewed retrospectively. Socioeconomic determinants included insurance status and race; outcomes included mortality, discharge disability and disposition. Correlations were identified using t test, Fisher’s exact test, and logistic regression. Results: The cohort comprised of 337 patients, with an overall uninsured rate of 5.6%. This rate was achieved by insuring 64.7% of the cohort after admission. Non-survivors were more likely to have no insurance coverage (14.8% versus 4.8%, p = 0.041). Regression revealed that uninsured had 8 times (95% CI 1.7–38.7, p = 0.008) higher in-hospital mortality than those with insurance when controlling for injury severity. Additionally, injury severity score ≥ 15, transfer from outside hospital, need for ICU or operative treatment were predictive of mortality. Adjusted risk factors for severe disability at discharge did not include insurance status or race, while ISS ≥ 15 and ICU stay were predictive. Conclusions: There are significant associations of insurance status with pediatric NAT outcomes, highlighting that determinants other than disease severity may influence mortality and morbidity. High-risk patients should be identified to develop strategies to improve outcomes.

Original languageEnglish (US)
JournalPediatric Surgery International
DOIs
StatePublished - Jan 1 2019

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Social Determinants of Health
Insurance Coverage
Pediatrics
Wounds and Injuries
Mortality
Injury Severity Score
Hospital Mortality
Insurance
Social Class
Logistic Models
Morbidity

Keywords

  • Insurance status
  • Non-accidental trauma
  • Pediatrics
  • Socioeconomic status

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

An investigation of social determinants of health and outcomes in pediatric nonaccidental trauma. / Jones, Ruth Ellen; Babb, Jacqueline; Gee, Kristin M.; Beres, Alana L.

In: Pediatric Surgery International, 01.01.2019.

Research output: Contribution to journalArticle

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