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Socioeconomic Disparities in Pediatric Traumatic Brain Injury Transfer Patterns: An Analysis of Area Deprivation
Joon Yong Chung1, Sabrina L Zeller2, Jared B Cooper2
1New York Medical College, Valhalla, New York, USA.
Insights
Pediatric traumatic brain injury (TBI) patients in high deprivation areas are more likely to be transferred to specialized centers. Socioeconomic factors influence transport modes and intensive care unit admissions, but not mortality.
Area of Science:
- Pediatric Traumatology
- Health Services Research
- Socioeconomic Determinants of Health
Background:
- Traumatic brain injury (TBI) in children causes significant long-term impairments.
- Timely transfer to specialized trauma centers is vital for pediatric TBI management.
- The impact of socioeconomic status, like the Area Deprivation Index (ADI), on TBI transfer patterns is understudied.
Purpose of the Study:
- To investigate the association between the Area Deprivation Index (ADI) and transfer patterns in pediatric TBI patients.
- To analyze the influence of socioeconomic factors on transport modes and clinical outcomes.
- To identify potential disparities in access to specialized pediatric trauma care.
Main Methods:
- Retrospective analysis of 359 pediatric TBI patients at a Level I Pediatric Trauma Center (2012-2023).
- Evaluation of transfer status, distance, transport mode, and clinical outcomes in relation to ADI.
- Statistical analysis using Student t-test and analysis of variance.
Main Results:
- 53.5% of patients were transferred; transfer patients had higher ADI scores (P<0.01).
- Air transport correlated with longer distances and higher ADI compared to ground ambulance (P<0.01).
- Intensive care unit admission rates varied by transfer mode, but mortality was not significantly impacted.
Conclusions:
- Higher ADI is linked to increased likelihood of transfer, indicating potential access disparities.
- Socioeconomic factors influence logistical aspects of pediatric TBI care.
- Integrating socioeconomic data may guide interventions to improve equitable care and outcomes for pediatric TBI patients.
Background:
Traumatic brain injury (TBI) poses a significant health burden, particularly among pediatric populations, leading to long-term cognitive, physical, and psychosocial impairments. Timely transfer to specialized trauma centers is crucial for optimal management, yet the influence of socioeconomic factors, such as the Area Deprivation Index (ADI), on transfer patterns remains understudied.
Methods:
A retrospective study was conducted on pediatric TBI patients presenting to a Level I Pediatric Trauma Center between January 2012 and July 2023. Transfer status, distance, mode of transport, and clinical outcomes were analyzed in relation to ADI. Statistical analyses were performed using Student t-test and analysis of variance.
Results:
Of 359 patients, 53.5% were transferred from outside hospitals, with higher ADI scores observed in transfer patients (P<0.01). Air transport was associated with greater distances traveled and higher ADI compared to ground ambulance (P<0.01). Despite similarities in injury severity, intensive care unit admission rates differed between transfer modes, with no significant impact on mortality.
Conclusions:
High ADI patients were more likely to be transferred, suggesting disparities in access to specialized care. Differences in transfer modes highlight the influence of socioeconomic factors on logistical aspects. While transfer did not independently impact outcomes, disparities in intensive care unit admission rates were observed, possibly influenced by injury severity. Integrating socioeconomic data into clinical decision-making processes can inform targeted interventions to optimize care delivery and improve outcomes for all pediatric TBI patients. Prospective, multicenter studies are warranted to further elucidate these relationships.
