title: Pediatric spinal injury in the US: epidemiology and disparities.
abstract: OBJECTIVE
  In the US, race and economic status have pervasive associations with mechanisms of injury, severity of injury, management, and outcomes of trauma. The goal of the current study was to examine these relationships on a large scale in the setting of pediatric spinal injury.
  
  
  METHODS
  Admissions for spinal fracture without or with spinal cord injury (SCI), spinal dislocation, and SCI without radiographic abnormality were identified in the Kids' Inpatient Database (KID) and the National Trauma Data Bank (NTDB) registry for 2009. Patients ranged in age from birth up to 21 years. Data from the KID were used to estimate nationwide annual incidences. Data from the NTDB were used to describe patterns of injury in relation to age, race, and payor, with corroboration from the KID. Multiple logistic regression was used to model rates of mortality and spinal fusion.
  
  
  RESULTS
  In 2009, the estimated incidence of hospital admission for spinal injury in the US was 170 per 1 million in the population under 21 years of age. The incidence of SCI was 24 per 1 million. Incidences varied regionally. Adolescents predominated. Patterns of injury varied by age, race, and payor. Black patients were more severely injured than patients of other races as measured by Injury Severity Scale scores. Among black patients with spinal injury in the NTDB, 23.9% suffered firearm injuries; only 1% of white patients suffered firearm injuries. The overall mortality rate in the NTDB was 3.9%. In a multivariate analysis that included a large panel of clinical and nonclinical factors, black race retained significance as a predictor of mortality (p = 0.006; adjusted OR 1.571 [1.141-2.163]). Rates of spinal fusion were associated with race and payor in the NTDB data and with payor in the KID: patients with better insurance underwent spinal fusion at higher rates.
  
  
  CONCLUSIONS
  The epidemiology of pediatric spinal injury in the US cannot be understood apart from considerations of race and economic status.
authors.affiliation: Nemours Neuroscience Center, AI duPont Hospital for Children, Wilmington, Delaware; and Departments of Neurological Surgery and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Piatt
mesh_terms: D000063:Accidents, Traffic / Q000191:economics / Q000706:statistics & numerical data; D000293:Adolescent; D001265:Athletic Injuries / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D044383:Black People / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D016103:Spinal Fractures / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D013123:Spinal Fusion / Q000706:statistics & numerical data; D013124:Spinal Injuries / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D015996:Survival Rate; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014754:Violence / Q000191:economics / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American
keywords: AUC = area under the curve; GCS = Glasgow Coma Scale; ISS = Injury Severity Scale; KID = Kids’ Inpatient Database; NTDB = National Trauma Data Bank; SCI = spinal cord injury; SCIWORA; SCIWORA = SCI without radiographic abnormality; TBI = traumatic brain injury; disparity; epidemiology; pediatric; spinal cord injury; spinal dislocation; spinal fracture; spine; trauma