K. A. Sonderman1, L. L. Wolf1, A. L. Beres2 1Brigham And Women’s Hospital,Boston, MA, USA 2University Of Texas Southwestern Medical Center,Children’s Health Dallas,Dallas, TX, USA
Introduction: Non-accidental trauma (NAT) is the leading cause of injury and death in early childhood. Previous studies have shown varied findings regarding the impact of insurance status, socioeconomic status, and race on mortality following NAT in children. As insurance is a modifiable factor, we sought to understand the independent impact of insurance status on mortality in a national sample of pediatric NAT.
Methods: We performed a retrospective cohort study using the 2012-2014 National Trauma Databank, including children ≤18y with NAT as defined by ICD-9 codes (967-968). Our primary outcome was death. We compared age, sex, race, insurance status, transfer status, and injury severity score (ISS) between patients that died and those that survived. We used multivariable logistic regression to calculate the adjusted odds of death by insurance status, controlling for the above variables with significant univariate associations.
Results: We identified 5,017 children with NAT. Mean age was 1.6y (SD 3.7), with 41% female, 51% white, 30% black, and 18% Hispanic. Majority of patients were publically insured (76%), 17.8% private, and 5.7% were uninsured. Mean injury severity score was 13.7 (SD 10.4). Half of patients were transferred to a higher level facility (49.1%). Overall, 414 (8%) patients died following NAT. Patients that died were younger (mean age 1.2y vs. 1.6y), more likely to be uninsured (13% vs. 5%), more likely to be transferred (55% vs. 49%) and more severely injured (mean ISS 25.6 vs. 12.6, Table). After adjusting for these factors, patients with no insurance had 3.6 greater odds of death compared to those with public insurance. There was no significant difference in the odds of death based on age, race, transfer status and ISS.
Conclusion: Pediatric patients who do not have insurance have significantly greater odds of death following NAT compared to children with public insurance. Further research may better elucidate the characteristics of these uninsured children that lead to greater likelihood of death following NAT.
