Assessment of Neighborhood Influence on Pediatric Trauma Outcome

Introduction: The Child Opportunity Index (COI) is a new measure that combines educational, health and environmental, and socioeconomic variables that have previously been associated with childhood development. This metric is publicly available for 100 US metropolitan areas. It is known that lower socioeconomic status is associated with increased risk of traumatic injury in children. To our knowledge, a multi-factorial comparison such as the COI has not been used to assess associations between neighborhood opportunity and outcomes of pediatric traumatic injury requiring hospital admission. For this study, we hypothesized that lower neighborhood opportunity is associated with unfavorable pediatric trauma outcomes.

Methods: With IRB approval, we queried the Trauma Registry Database at a level I trauma center in an urban, academic children’s hospital between July 2011 and June 2016. Data collected included demographics, patient disposition, type of trauma, and injury severity score (ISS). Patient addresses were geocoded to census tracts, which were then matched to COI data. Patients were classified as living in one of 5 levels of opportunity: very low, low, moderate, high, and very high. Children without COI data were excluded.

Results: There were 467 children included in this 5-year study. The median age was 9.0 years [4.0-13.1]; 60.3% were African-American and 34.9% were Caucasian. Most children suffered blunt trauma (89.7%), while 10.2% had penetrating trauma. Over half of children (55.7%) in this cohort were living in very low or low opportunity neighborhoods. There were no differences in ISS scores (2 [1-9] vs. 4 [1-9]; p=0.238) or trauma activation level (full vs. partial; p=0.328) between children living in very low or low opportunity versus higher opportunity neighborhoods. Children living in lower opportunity neighborhoods were more likely to be African American (84.2% vs 30.4%; p<0.001), less likely to require PICU admission (20.4% vs. 29.0%; p=0.041), and more likely to suffer penetrating trauma (19.4% vs 2.9%; p<0.001) compared to those children living in higher opportunity neighborhoods.

Conclusion: In this study, we found that children living in lower opportunity neighborhoods were more likely to be African American, more likely to suffer a penetrating trauma, and less likely to require PICU admission. Utilizing a multi-factorial assessment such as the COI metric to analyze trauma outcomes could show that neighborhood influence has a correlation with poor trauma outcomes. The COI may be a useful metric for identifying social risk factors for pediatric traumatic injury and warrants further investigation.