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Published on: January 20, 2023
Socioeconomic characteristics of pediatric traumatic brain injury patients
Irim Salik1, Jose F Dominguez2, Sima Vazquez3
1Department of Anesthesiology, Westchester Medical Center, Valhalla, NY, United States of America.
Insights
Poor socioeconomic status (PSES) in pediatric traumatic brain injury (pTBI) patients is linked to higher mortality, longer hospital stays, and more complications. Addressing these disparities is crucial for improving care and resource use in pTBI treatment.
Area of Science:
- Pediatric Traumatology
- Public Health
- Health Services Research
Background:
- Traumatic brain injuries (TBIs) significantly impact pediatric mortality and morbidity.
- Environmental factors may influence the type, severity, and outcomes of pediatric TBIs (pTBIs).
- The influence of poor socioeconomic status (PSES) on pTBI requires detailed characterization.
Purpose of the Study:
- To investigate the impact of PSES on the incidence, treatment, and outcomes of pediatric TBI patients.
- To analyze demographic, treatment, and outcome data in relation to socioeconomic factors.
- To identify disparities in pTBI care associated with PSES.
Main Methods:
- Utilized the Kids' Inpatient Database (KID) from 2016-2019.
- Identified pediatric TBI cases using International Classification of Disease, 10th revision (ICD-10) codes.
- Defined PSES using Medicaid insurance and Q1 median income categories; extracted demographic, complication, procedure, and outcome data.
Main Results:
- Out of 26,417 pTBI patients, 41.8% were on Medicaid and 30.9% were in the Q1 income category.
- PSES patients were more likely to experience assault (OR 2.927 for Medicaid, OR 2.033 for Q1 income).
- Propensity-matched analysis revealed PSES was associated with increased mortality (OR 1.667), longer length of stay (LOS) (OR 1.369), and major complicated trauma (OR 1.354). Total hospital charges were higher for Medicaid patients.
Conclusions:
- PSES is significantly correlated with increased mortality, complications, and longer LOS in pediatric TBI patients.
- Healthcare coverage and clinical training must account for socioeconomic disparities.
- Optimizing healthcare resource utilization and improving care for pTBI patients requires addressing these identified disparities.
Background:
Traumatic brain injuries (TBIs) play a significant role in pediatric mortality and morbidity. Environment may play a role in the type, severity, and outcome of pediatric TBI (pTBI). Our objective was to characterize the impact of poor socioeconomic status (PSES) on the incidence, treatment, and outcomes of pTBI patients.
Methods:
The Kids' Inpatient Database (KID) was queried from 2016 to 2019 for with TBI using International Classification of Disease, 10th revision (ICD 10) codes. Data defining demographics, complications, procedures, and outcomes was extracted. PSES was defined as Medicaid insurance and Q1 median income category.
Results:
26,417 patients had pTBI. 11,040 (41.8 %) of pTBI patients were on Medicaid insurance. 13,119 and 8165 (30.9 %) were in Q1 median income category. Land transport caused the majority of pTBI (41 %). Patients on Medicaid or Q1 median income were more likely to experience assault (OR 2.927, CI 95 % 2.455-3.491, p < 0.001 OR 2.033, CI 95 % 1.722-2.4000 p < 0.001 respectively). On propensity matched analysis, PSES was associated with increased mortality (OR 1.667, 95 % CI 1.322-2.100, p < 0.01), length of stay (LOS) (OR 1.369, 95 % CI 1.201-1.559, p < 0.01), and major complicated trauma (OR 1.354 95 % CI 1.090-1.682 p = 0.007). Total hospital charges were higher in pTBI patients on Medicaid ($112,101.52, +/- $203,716.35) versus non-Medicaid ($109,064.37 +/- $212,057.98) (p < 0.001).
Conclusion:
PSES is correlated with increased mortality, complications, and longer LOS. Healthcare coverage and clinical training should take these disparities into account to provide improved care and optimize healthcare resource utilization.
Level Of Evidence:
Level IV, Retrospective Database.
