Health disparities analysis of critically ill pediatric trauma patients in Milwaukee, Wisconsin

Abstract

Background: Injury is the leading cause of childhood morbidity and mortality in the US. The associated costs exceed $20 billion annually. This study examined disparities in disadvantaged populations of critically injured pediatric patients admitted to a level 1 pediatric trauma center.

Study design: A retrospective study was conducted of all trauma patients admitted to the pediatric intensive care unit (PICU) at a level 1 pediatric trauma hospital from 2005 to 2009.

Results: Data on 324 patients were analyzed; 45% of patients were Caucasian, 33% were African American, 12% were Hispanic, and 10% were other. There was no difference in age, Glasgow Coma Scale (GCS), or Injury Severity Score (ISS) across ethnic groups. The mortality rate was 12%. A higher percentage of Caucasians were commercially insured and from the highest income quartile than non-Caucasians (p < 0.001). African Americans had the highest rate of penetrating trauma and intentional injury compared with other ethnicities (p < 0.001). Nearly 75% of firearm injuries were clustered in 7 ZIP codes with the lowest median household incomes. The home was the most common location for firearm injuries. Children involved in assaults were more likely to have a single parent (67%) than 2 parents (26%, p < 0.001). Both ethnicity and payer status were significantly associated with mortality.

Conclusions: Significant disparities in socioeconomic status exist in severely injured pediatric patients treated in the PICU. Disparities were associated with adverse outcomes. These results should inform community and public health efforts to identify the areas and populations at highest risk for violence-related injuries.

Keywords: GCS; Glasgow Coma Scale; ISS; Injury Severity Score; PICU; SES; VPICU Performance Systems Database; VPS; pediatric ICU; socioeconomic status.

Figure 1

Youth firearm injuries and median household income in Milwaukee County by zip code tabulation area, 2005-2009. This map shows the zip code tabulation area where a firearm injury occurred in Milwaukee County among a pediatric population. Data sources: Case data is from the Children's Hospital of Wisconsin's trauma registry and VPICU Performance Systems (VPS) database. Both the median household income data (2000 US Census) and the ZCTA borders are from the US Census Bureau.