Pediatric Trauma Mortality Differs by Neighborhood Opportunity Level.

Autor: O'Guinn ML; Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA. Electronic address: MOguinn16@gmail.com., Ginther A; Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA., Ourshalimian S; Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA., Spurrier RG; Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA; Keck School of Medicine of the University of Southern California, Department of Surgery, 1975 Zonal Ave, Los Angeles, CA, 90033, USA., Chaudhari PP; Children's Hospital Los Angeles, Division of Emergency Medicine &Transport Medicine, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA; Keck School of Medicine of University of Southern California, Department of Pediatrics, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2024 Sep 21, pp. 161950. Date of Electronic Publication: 2024 Sep 21.
DOI: 10.1016/j.jpedsurg.2024.161950
Abstrakt: Objective: Traumatic injuries are a leading cause of death in children and a child's neighborhood characteristics can be a risk factor. Our objective was to describe the association between pediatric trauma mortality and Child Opportunity Index (COI).
Methods: A multicenter, retrospective cross-sectional study was conducted across 15 trauma centers from 2010 to 2021 within a large metropolitan county to evaluate trauma activation mortalities involving children <18 years-old. We examined clinical and demographic data from the county trauma registry and linked home zip code to COI, a measure of neighborhood level resources critical for children's development. Proportion of mortalities were compared to the proportion of children within each COI quintile and injury mechanism was evaluated across COI quintile. Analysis was performed using Kruskal-Wallis and chi-square tests (α = 0.05).
Results: Of 31,702 pediatric trauma activations, 513 (1.6%) mortalities occurred. Mortalities mostly resulted from assaults (37.0%), pedestrian injuries (26.7%), and motor-vehicle collisions (18.7%). Of all mortalities, 32.6% were firearm related, either from an assault or self-inflicted. A greater proportion of mortalities were children from very low (47.6%) and low (20.9%) COI neighborhoods with fewer from higher (8.8.% and 7.6%) COI-neighborhoods compared to the county's proportion of children within these quintiles (p < 0.001). The injury mechanisms were different, with mortalities of lower COI neighborhoods being associated with assaults (p = 0.005), while mortalities of higher COI neighborhoods were self-inflicted (p = 0.003).
Conclusion: Lower opportunity neighborhoods had a higher incidence of pediatric trauma mortality. Mortality mechanism varied across neighborhoods with assault greater in lower opportunity neighborhoods and self-inflicted among higher opportunity neighborhoods.
Level of Evidence: Level III.
Competing Interests: Conflict of interset None.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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