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Abstract
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INTRODUCTION: While pediatric trauma centers (PTCs) and adult trauma centers (ATCs) exhibit equivalent trauma mortality, the optimal care environment for traumatically injured adolescents remains controversial. Race has been shown to effect triage within emergency departments (EDs) with people of color receiving lower acuity triage scores. We hypothesized that African-American adolescents were more likely triaged to an ATC than a PTC compared to their Caucasian peers.
METHODS: Institutional trauma databases from a neighboring, urban level one PTC and ATC were queried for gunshot wounds in adolescents (15-18 years old) presenting to the ED from 2015-2017. The PTC and ATC were compared in terms of demographics, services, and outcomes.
RESULTS were analyzed using univariate analysis and logistic regression.
RESULTS: Among 316 included adolescents, 184 were treated in an ATC versus 132 in a PTC. Patients at the PTC were significantly more likely to be younger (16.1 vs 17.5 years old, p < 0.001), Caucasian (16% vs 5%, p = 0.001) and privately insured (41% vs 30%, p = 0.002). At each age, the proportion of Caucasians treated at the PTC exceeded the proportion of African Americans (Figure 1). At the PTC, patients were more likely to receive inpatient and outpatient social work follow-up (89% vs 1%, p < 0.001). Adolescents treated at the PTC were less likely to receive opioids (75% vs 56%, p = 0.001) at discharge and to return to ED within six months (25% vs 11%, p = 0.005). On multivariate logistic regression, African American adolescents were less likely to be treated at a PTC (OR = 0.30, 95% CI 0.10, 0.85, p = 0.02) after controlling for age and injury severity score.
CONCLUSION: Disparities in triage of African-American and Caucasian adolescents after bullet injury leads to unequal care. African-Americans were more likely to be treated at the ATC, which was associated with increased opioid prescription, decreased social work support, and increased return to ED. LEVEL OF EVIDENCE: Retrospective study, level IV.
Language: en |