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Published on: February 23, 2024
Social Determinants of Health Affect Long-Term Burn Care in Pediatric Patients
Katherine Bergus1, Sydney Castellanos2, Taha Akbar1
1Department of Pediatric General Surgery, Nationwide Children's Hospital, Columbus, OH 43205, United States.
Insights
Pediatric burn patients lacking a primary care provider (PCP) or requiring surgery are more likely to miss crucial outpatient follow-up appointments, potentially impacting burn recovery. Addressing social determinants of health is key.
Area of Science:
- Pediatric Burn Care
- Social Determinants of Health
- Healthcare Access
Background:
- Outpatient follow-up is critical for optimizing outcomes in pediatric burn patients.
- Social determinants of health (SDH) significantly impact families' ability to attend follow-up appointments.
- This study investigates the association between SDH and missed outpatient burn follow-up, hypothesizing inferior burn-related outcomes for those missing appointments.
Purpose of the Study:
- To identify social determinants of health associated with missed outpatient follow-up appointments in pediatric burn patients.
- To determine the impact of missed appointments on burn-related outcomes.
- To inform interventions aimed at improving follow-up adherence.
Main Methods:
- Retrospective cohort study of pediatric burn patients (<18 years) admitted between 2021-2022.
- Data collected included demographics, injury details, SDH assessments, and postinjury complications.
- Multivariate regression analysis was used to identify independent predictors of missed follow-up.
Main Results:
- Forty-six percent of 322 pediatric burn patients missed at least one outpatient appointment.
- Independent predictors of missed follow-up included lacking a primary care provider (PCP) (aOR 6.10) and requiring surgical burn management (aOR 3.13).
- Patients who missed appointments were also more likely to be exposed to tobacco/illicit substances.
Conclusions:
- Lack of a PCP and need for surgical intervention are significant predictors of missed outpatient follow-up in pediatric burn patients.
- Targeted interventions, including establishing PCP care prior to discharge, are needed to improve follow-up adherence.
- Addressing SDH is crucial for optimizing long-term outcomes in pediatric burn survivors.
Abstract:
For pediatric burn patients, outpatient follow-up is essential to optimize outcomes. Social determinants of health (SDH) influence families' ability to attend clinic follow-up appointments. We hypothesize that SDH differences are associated with missing outpatient burn follow-up and therefore inferior burn-related outcomes. We performed a retrospective cohort study of patients <18 years of age who were admitted to our pediatric burn center during 2021-2022. Patient demographics, injury and management details, social work SDH assessment, and post-injury complications were collected. Multivariate regression was conducted to identify independent predictors of missed follow-up. Among 322 patients, median age at injury was 2.5 years (IQR: 1.4-7.8). Most patients were male (60.2%) and most were White (56.0%). About 46% of patients missed one or more appointment. Patients who missed appointments less often had a primary care provider (PCP) (91.3% vs 98.1%; P = .007) and were more commonly exposed to tobacco/illicit substances (31.8% vs 21.3%; P = .03). Patients who attended all appointments more often had their burns managed non-surgically (81.6% vs 62.8%, P < .0001). Controlling for relevant clinical factors, independent predictors of missing appointments included not having a PCP (aOR 6.10; 95% CI, 1.25-29.81) and requiring surgical burn management (aOR 3.13; 95% CI, 1.65-5.95). Next steps include collaborating with social work to improve support and resources for patients who are at increased risk for letting their outpatient burn care lapse. This may include establishing a PCP prior to discharge, particularly among patients requiring more extensive burn management.
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