C. M. Courtney1, E. J. Onufer1, P. M. Choi1, N. A. Wilson1, A. M. Vogel1, M. S. Keller1 1Washington University,St. Louis, MO, USA
Introduction: Healthcare disparities, based on insurance status, exist in trauma patients. We sought to determine if any disparities exist in pediatric trauma patients at our institution. Specifically, we looked at certain injury patterns and patients transferred from outside hospitals.
Methods: A retrospective review of all pediatric trauma patients was conducted at a single, ACS and State verified Level-1 pediatric trauma center from 1/1/2009 to 12/31/2014. Patients were categorized by their insurance status [Private Insurance (PI), Medicaid (MC), or Self-Pay (SP)]. Continuous data were analyzed using analysis of variance (ANOVA). Categorical data were analyzed using chi-square test for frequencies.
Results: A total of 7937 trauma patients were included, of which there were 3677 with PI (46.3%), 3725 patients with MC (46.9%), and 535 patients with SP (6.7%). Overall Injury Severity Scores (ISS) were low, and there were no statistically significant differences in between groups. There were also no differences in the total time spent in the Emergency Department (ED) or in the percentage of patients receiving CT scans between payer status.
We next examined management and outcomes based on insurance status. More SP patients were discharged home from the ED following evaluation compared to both PI and MC patients. The SP group had the highest mortality, followed by MC, and PI (SP: 3.4% vs MC: 1.3% vs PI: 0%, p < 0.0001). When specific injury patterns were analyzed, we found that the SP group had increased incidence of penetrating injury as well as an increased Chest Abbreviated Injury Score (Table 1). Mortality was also higher in SP patients suffering from blunt trauma (SP: 2.1% vs MC: 1.1% vs PI: 0%, p < 0.0001).
4892 patients (61.6%) were outside hospital transfers. In this cohort of patients, there were no differences in ISS between insurance groups. (PI: 5.4±0.1, MC: 5.6±0.1, SP: 5.7±0.5). There were also no differences in the percentage of patients receiving CT scans at outside hospitals according to payer status. This persisted even when patients were stratified by ISS.
Conclusion: Insurance status does not seem to impact the frequency of initial CT evaluation, even in patients transferred from outside hospitals. However, healthcare disparities continue to exist in pediatric trauma. This is particularly true in SP patients who are more commonly discharged home from the ED. These patients also have an increased frequency of both penetrating injury and mortality. Further research into healthcare disparities within this high risk population may reduce costs but also may save lives.