Pediatric traumatic brain injury: do racial/ethnic disparities exist in brain injury severity, mortality, or medical disposition?
BACKGROUND
Little is known regarding pediatric racial/ethnic disparities. We sought to determine if racial/ethnic disparities exist in the severity, mortality, or medical disposition of pediatric traumatic brain injury (TBI).


METHODS
We analyzed data from a comprehensive trauma database assembled at a large independent children's hospital. Among all patients evaluated by the trauma service in the emergency department (ED), cases of TBI were identified (N=1035). Analyses contrasted non-Hispanic White children with all others (minority children). The relationship of race to patient characteristics, brain injury severity, mortality, and medical disposition (hospital admission, intensive care unit admission) was analyzed by using bivariable approaches and multivariate logistic regression. The latter controlled for age, overall injury severity, and insurance status.


RESULTS
Although sociodemographic characteristics did not differ, the mechanism of injury was significantly different (P<.001); minority children were more likely to have been a pedestrian or cyclist struck by a vehicle. Minority children were less likely to require transfer to the ED for treatment and were more likely to be publicly insured (P<.001). No differences in brain injury severity, mortality, or medical disposition were observed with both bivariable and multivariable approaches.


CONCLUSIONS
This study is one of the first to examine potential disparities in trauma and contributes to the small but growing literature in pediatric health disparities. Multiple explanations are explored, several with potential implications for reducing disparities in other health conditions. Identifying conditions in which evaluation and treatment appears to be free of disparities may provide insights for subsequent investigations and interventions.
Howard
Ivory
I
Center for Neuroscience Research, Children's National Medical Center, USA.
Joseph
Jill G
JG
Natale
JoAnne E
JE
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D008873:Mid-Atlantic Region; D012720:Severity of Illness Index; D013223:Statistics as Topic