G. M. Siegel3, T. Lee3, C. Wakefield3, A. Katrikh3, D. Webster3, J. Poirier1, J. Mis2, A. Shah1, M. Kaminsky2 1Rush University Medical Center,Pediatric Surgery,Chicago, IL, USA 2John H. Stroger, Jr. Hospital of Cook County,Trauma,Chicago, IL, USA 3Rush Medical College,Chicago, IL, USA
Introduction: In Chicago, gun violence significantly impacts individuals younger than eighteen. In 2017, 16% of shootings involved individuals younger than eighteen years of age with 115 resulting in a fatality. It is well-established that pediatric patients are at greater risk for failure to follow-up (FTF) after a penetrating trauma. Existing literature on trauma follow-up does not explicitly examine FTF among pediatric trauma patients at a safety net, level one trauma center that serves an area with high incidence of gun violence. A better understanding of how to serve this complex population may aid in reducing recidivism, adverse outcomes post-discharge, and the perpetuation of violent crime. We sought to assess patterns and rates of FTF across specialties, emergency department (ED) utilization, and re-hospitalization for surgical pediatric patients post-penetrating trauma at a publicly funded level-one trauma center in Chicago.
Methods: A retrospective cohort study was conducted on surgical patients (ages 0-18) with penetrating trauma admitted from 2008-2016. To examine potential predictors of FTF, nested linear models were created and compared from EMR data and U.S. Census Bureau data.
Results: We reviewed the records of 216 patients (average age of 15.8 ± 3.6) that suffered a penetrating traumatic injury (73.1% assault with a firearm) with an injury severity score (ISS) of 11.6 ± 13.9. These individuals reside in ZIP Codes with a median household income of $37,372, which was significantly below the city of Chicago median of $66,020 in 2016. Overall follow-up compliance rate was 65.9% with a 16% post-discharge ED visit and 9.3% re-hospitalization rate within 12 months. Ethnicity (p=0.01) and ethnicity, sex, and race (p=0.04) in combination were found to be independent predictors of follow-up compliance. ICU length of stay, hospital length of stay, and ISS did not predict follow-up compliance (p-values 0.09 to 0.78).
Conclusion: We found marked differences in overall patterns and rates among the pediatric trauma population in terms of ED recidivism and FTF than cited in previous literature. Further study is necessary to expand our sample population and determine characteristics driving follow-up, ED utilization, and re-hospitalization among pediatric trauma patients in low-socioeconomic communities with a high burden of gun violence. Additionally, decreasing FTF and improving the quality of post-discharge care is a potential mechanism for cost-containment and reducing long-term recidivism. Establishing benchmarks for pediatric trauma follow-up and assessing post-discharge outcomes for pediatric patients should be a priority for all trauma centers.