Statewide Analysis of Racial Disparities and Assault in Pediatric Trauma Patients

Background/Purpose: Black children experience an inequitable burden of violence. This study analyzed data from the Ohio trauma registry that includes 90% of Ohio hospitals including a large number of non-trauma centers.  Therefore, this is the first statewide analysis of racial disparities in assault for pediatric patients.

Methods:Assault was identified in 653 patients under 16 years old. Data were compared by race for 653 patients < 16 years old using a chi-square test. Logistic regression evaluated associations between race and mortality adjusting for injury severity score (ISS).

Results/Outcomes: 51% of white children were < 1yr old compared to 26% of black children (p<0.001).  14-15 year old black children suffered the highest proportion of assaults (36% vs 9%). Black children were more likely undergo an operative procedure  (29% vs 14%, p<0.001), experience a complication (14% vs 2%, p<0.001) a penetrative injury (42% vs 8%, p<0.0001), or firearm-related injury(14% vs 7%, p<0.0001).  87% went directly to at trauma center vs 75% of white children (p<0.001). Black children were more likely to die after adjusting for ISS (OR=2.1, 95%CI 1.2-3.6) Days between injury and arrival were significantly longer for black children.

Conclusions:  Assault is most prevalent in white children less than one year old, suggesting abuse compared to adolescent black children who have a high proportion of firearm injuries and sustain more severe injuries.  Black children tend to have closer proximity to trauma centers yet have a delay in care and twice the mortality rate even after adjusting for severity.