O. S. Henry1, A. S. Rooney4, M. V. Heflinger1, A. G. Sykes3, K. M. Kling2, D. A. Lazar2, M. J. Martin4, V. Bansal4, R. C. Ignacio2 1Rady Children’s Hospital – San Diego, Pediatric Surgery Division, San Diego, CA, USA 2University of California San Diego Medical School, San Diego, CA, USA 3Naval Medical Center San Diego, General Surgery Department, San Diego, CA, USA 4Scripps Mercy Hospital, San Diego, CA, USA
Introduction:
Healthcare disparities in pediatric trauma can affect overall morbidity and mortality. However, there is a paucity of data to describe how socioeconomic characteristics and neighborhood disadvantage correlate with specific injuries and outcomes. The purpose of this study is to assess the relationship of neighborhood socioeconomic disadvantage to bicycle safety and trauma outcomes among pediatric bike vs. auto injuries.
Methods:
Patients ≤18 years old with bike vs. auto injury mechanism from a Level 1 pediatric trauma center admitted from January 2008-December 2018 were evaluated. Area Deprivation Index (ADI) was used to measure neighborhood socioeconomic disadvantage based on patient home address. Patient demographics, injury, and clinical data characteristics [admit Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Abbreviated Injury Scores (AIS)] were analyzed. Outcomes included hospital length of stay, ICU admission, complications, hospital readmission, and mortality. Traffic scene data from the Statewide Integrated Traffic Records System (SWITRS) were matched to clinical records. Bicycle safety was assessed by helmet usage, road conditions, and the presence of bike lanes. Multivariate logistic regression was used to assess demographic characteristics related to helmet usage.
Results:
A total of 321 patients were evaluated, 84% male, median age of 12 years [IQR 9-13], and 44% were of Hispanic ethnicity. Hispanic ethnicity was greater in the most disadvantaged ADI groups (69%), compared to the middle (13%), or least disadvantaged ADI groups (18%; p<0.001). There were no differences in admit GCS, ISS, length of stay, ICU admission, complications, readmission, or mortality by ADI, although there was a significant difference in Head and Neck AIS by ADI (p=0.01). Mortality occurred in two patients and most (96%) were discharged to home. Of the SWITRS matched traffic records, 14% of collisions occurred in non-daylight and 79% were at locations without a bike lane. The most disadvantaged ADI group was least likely to have worn a helmet (see Figure 1; p<0.001). Hispanic ethnicity and highest deprivation group were independently associated with lower odds of wearing a helmet (AOR 0.4, 95% CI 0.1-0.9, p=0.03; AOR 0.33 95% CI 0.17-0.62; p=0.001), while patient age and sex were unrelated to helmet usage.
Conclusion:
Outcomes for bike vs. auto trauma remain similar across all ADI groups. However, bike helmet usage is significantly lower among children from greater disadvantaged neighborhoods. This research may help support targeted local education and prevention programs to improve bike safety and helmet usage among those at increased risk.
