The impact of regionality and hospital status on mortality associated with non-accidental trauma
| Autor: | Adil A. Shah, Wasay Nizam, Anthony D. Sandler, Faraz A. Khan, Paul Manicone, Muhammad Maaz Zuberi, Timothy D. Kane, Mikael Petrosyan |
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| Rok vydání: | 2022 |
| Předmět: |
Child abuse
Databases Factual Pediatric health Ethnic group Logistic regression 03 medical and health sciences Injury Severity Score 0302 clinical medicine Trauma Centers 030225 pediatrics Humans Medicine Child Abuse Hospital Mortality Child Retrospective Studies business.industry Mortality rate Infant 030208 emergency & critical care medicine General Medicine Hospitals Pediatric Quartile Accidental Insurance status Surgery business Demography |
| Zdroj: | The American Journal of Surgery. 223:238-242 |
| ISSN: | 0002-9610 |
| DOI: | 10.1016/j.amjsurg.2021.06.014 |
| Popis: | Introduction Non-accidental trauma (NAT) affects 2 per 100,000 children annually in the US and may go unrecognized. The aim of this study to quantify the burden of NAT and to evaluate regional variations in mortality. Methods The Kids Inpatient Database (2000–2012) was queried for pediatric patients presenting with a diagnosis of NAT. Data was obtained on demographic, clinical and hospital-level characteristics. Primary outcome measure was mortality. Multivariable logistic regression models for age, sex, race/ethnicity, insurance status, income quartile, hospital volume, region (Northeast, South, West and Midwest), teaching status, and injury severity scores. Results NAT represented 1.92% (n = 15,999) of all trauma patients. Mortality rates were 3.98% for patients presenting with NAT. African American children had a higher likelihood of mortality compared to White children (OR[95%CI]:1.35[1.03–1.79]), however, this effect was not statistically significant for patients being treated at designated children's hospitals (OR[95%CI]:1.23(0.78–1.95) and urban facilities (OR[95%CI]:1.30[0.99–1.72]). Statistically significant regional variations in mortality, lost significance for patients treated at designated children's hospitals (p > 0.05). Conclusion NAT has devastating consequences and is associated with a high mortality rate. Treatment at designated children's hospitals results in the loss of variation in mortality, resulting in diminished disparities and improved outcomes. These findings align with current trends towards the “regionalization of pediatric health care” and reflects the value of regional transfer centers that are. |
| Databáze: | OpenAIRE |
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