Cross-sectional study addressing paediatric trauma disparities: a demographic analysis using injury pyramids
Briana Lewis1, Willie Leung2, Rebecca Olsen2
1The RAND School of Public Policy, Santa Monica, California, USA blewis@rand.org.
Insights
Paediatric trauma disparities are evident, with injury pyramids highlighting differences in emergency visits, hospitalizations, and deaths. Targeted prevention strategies are crucial for vulnerable populations, addressing social determinants of health.
Area of Science:
- Public health
- Paediatric trauma research
- Health equity
Background:
- Paediatric injuries are a major global health concern, disproportionately impacting vulnerable groups.
- Social determinants of health, including socioeconomic status, race, and insurance, significantly affect injury outcomes.
- Injury pyramids offer a visual tool to understand and address these disparities.
Purpose of the Study:
- To analyze paediatric trauma incidence and outcomes using injury pyramids.
- To identify disparities in paediatric trauma based on demographic and socioeconomic factors.
- To inform targeted prevention strategies and policy development.
Main Methods:
- Retrospective cohort analysis of 6466 paediatric trauma cases (2010-2021).
- Calculation of incidence rates per 100,000 persons for emergency visits, hospitalizations, and deaths.
- Stratification by sex, age, race, county, and insurance type, with statistical analysis using chi-squared tests.
Main Results:
- Overall incidence rates: 88.6 emergency visits, 47.6 hospitalizations, and 2.4 deaths per 100,000 persons.
- Leading causes: Falls, motor vehicle crashes (MVCs), and sports injuries for visits/hospitalizations; drowning, MVCs, and gunshot wounds for deaths.
- Disparities observed: Higher firearm fatalities in Black children, higher drowning/MVC fatalities in White children. Publicly insured children had greater injury severity.
Conclusions:
- Injury pyramids effectively reveal paediatric trauma disparities, guiding population-specific prevention.
- These pyramids are valuable for intervention development, health equity, and policy.
- Integrating frameworks like the Haddon Matrix and Injury Equity Framework can deepen understanding of social contributors.
Background:
Paediatric injuries are the leading cause of morbidity and mortality worldwide, with unintentional trauma disproportionately affecting vulnerable populations. Social determinants of health, including socioeconomic status, race and insurance type, significantly influence injury outcomes. Injury pyramids serve as a valuable tool for visualising these disparities and informing targeted prevention strategies.
Methods:
A retrospective cohort analysis was conducted on 6466 paediatric trauma cases recorded at St. Joseph's Children's Hospital (2010-2021) in Tampa, Florida. Incidence rates per 100 000 persons were calculated for emergency department visits, hospitalisations and deaths, stratified by sex, age, race, county and insurance type. χ² analysis assessed statistical significance.
Results:
The injury pyramid revealed 88.6 emergency visits, 47.6 hospitalisations and 2.4 deaths per 100 000 persons. Falls, motor vehicle crashes and sports-related injuries were the leading causes of emergency visits and hospitalisations. Drowning, motor vehicle crashes and gunshot wounds were the primary causes of death. Black children had a higher incidence of firearm-related fatalities, while White children had higher rates of drowning and motor vehicle fatalities. Publicly insured children exhibited greater injury severity compared with those with private insurance.
Conclusions:
Injury pyramids effectively highlight paediatric trauma disparities, emphasising the need for population-specific prevention strategies. Injury pyramids are effective in intervention development, mitigating health disparities and informing policy development. The integration of conceptual frameworks such as the Haddon Matrix and Injury Equity Framework may enhance understanding of the social and structural contributors to paediatric trauma disparities.
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