Comparing neighborhood deprivation metrics in pediatric trauma: Is there a better predictor?

Neighborhood deprivation (ND) impacts pediatric trauma, the leading cause of mortality in children. The aim of this work was to compare the association of three common neighborhood deprivation metrics (NDMs) with pediatric trauma mechanisms and injury severity.

This was a retrospective analysis of trauma patients ≤18-years-old presenting to a single level 1 pediatric trauma center from 1/2016 to 12/2021. NDMs utilized were the Area Deprivation Index (ADI), Childhood Opportunity Index (COI), and Social Vulnerability Index (SVI). Patients were divided into NDM quintiles. Descriptive statistics were used to compare the baseline characteristics of the study population. Univariable regression models were fit to examine the association with pediatric trauma mechanisms and severity. The area under the curve (AUC) was calculated and compared with a contrast test. The same analysis was performed for multivariable regressions.

Higher ND patients were younger, more often of Black race or Hispanic/Latinx ethnicity, and had government/Medicaid insurance. A higher percentage of auto-pedestrian, motor vehicle collisions (MVC), non-accidental trauma (NAT)/assault/neglect, and penetrating injuries occurred at high ND. Models incorporating COI had the highest predictive ability for MVC, sports, and ICU length-of-stay (LOS) ≥ 3 days. Models incorporating ADI had the highest predictive ability for Intensive Care Unit (ICU) admission, and Injury Severity Score (ISS) > 15. These differences in predictive ability persisted on multivariable analysis for sports, ISS >15, and ICU LOS ≥3 days.

The NDMs were all associated with differences in injury mechanism/severity and can be used as ND markers in future pediatric trauma research.

Retrospective cross-sectional analysis.

Level IV.