Neighborhood Disadvantage and Injury Mechanism, Severity, and Outcomes in Pediatric Trauma

Emily K Myers; Keren Eyal; Jose L Diaz-Miron; Kaci L Pickett-Nairne; Jaclyn E Orehova; Sarah C Vangi; Mark B Malham; Lauren R S Hill; Kathleen M Adelgais; Jonathan L Hills-Dunlap; Marina L Reppucci; Shannon N Acker

doi:10.1016/j.jpedsurg.2024.162084

Neighborhood Disadvantage and Injury Mechanism, Severity, and Outcomes in Pediatric Trauma

J Pediatr Surg. 2024 Dec 5;60(3):162084. doi: 10.1016/j.jpedsurg.2024.162084. Online ahead of print.

Affiliations

¹ University of Colorado School of Medicine, 13001 E. 17th Pl., Aurora, CO 80045, USA. Electronic address: emily.k.myers@cuanschutz.edu.
² University of Colorado School of Medicine, 13001 E. 17th Pl., Aurora, CO 80045, USA; Children's Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA.
³ University of Colorado School of Medicine, 13001 E. 17th Pl., Aurora, CO 80045, USA.
⁴ Children's Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA.

PMID: 39693823
DOI: 10.1016/j.jpedsurg.2024.162084

Abstract

Background: Traumatic injuries remain the leading cause of death in children aged 1-14. Previous research demonstrates a link between lower socioeconomic status (SES) and higher pediatric injury morbidity and mortality. There is scant research exploring the relationship between neighborhood disadvantage and pediatric trauma. This study utilizes Area Deprivation Index (ADI) to understand the relationship between pediatric traumatic injury mechanisms, severity, and outcomes and neighborhood disadvantage.

Methods: We performed a single-center cross-sectional analysis of pediatric trauma patients aged 0-18 presenting to our Level 1 Pediatric Trauma Center from 2016 to 2021. Patients were stratified into quintiles by national ADI. Injury mechanisms and severity markers were analyzed across ADI quintiles. A subset analysis was also performed, comparing complications and outcomes across ADI quintiles for severely injured patients.

Results: Children from areas of higher disadvantage experienced higher rates of injuries related to automobiles, non-accidental trauma (NAT)/assault/neglect, penetrating injuries, and thermal injuries (p < 0.001). Children from areas of low disadvantage incurred more injuries related to sports (p < 0.001) and falls (p = 0.002). Multiple markers of trauma severity increased with increasing neighborhood disadvantage. No differences were found in clinical outcomes in the subset of most severely injured children.

Conclusions: Mechanisms and severity of traumatic injuries among children vary with degree of neighborhood disadvantage. Outcomes did not differ by ADI quintile in the most severely injured children. ADI may be a tool for identifying children at higher risk for certain injury mechanisms and more severe injuries and could be used to target injury prevention interventions to more vulnerable communities.

Type of study: Retrospective cross-sectional analysis.

Level of evidence: Level IV.

Keywords: Injury prevention; Neighborhood-level disparities; Outcomes; Pediatric trauma.