Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Curr Opin Pediatr. 2010 Jun;22(3):321-5. doi: 10.1097/MOP.0b013e3283395f13.
The purpose of this review is to highlight recent advances in understanding the epidemiology of pediatric trauma and the impact of health disparities on care of the injured child.
Recent studies examining outcomes for injury in children consistently demonstrate worse clinical and functional outcomes for minority children compared with white children, with African-American race being an independent predictor of mortality. Despite controlling for injury severity and insurance status (as a surrogate of socioeconomic status), these disparities persist. Significant racial differences in mortality were also identified when national data were compared with local institutional data for children with traumatic brain injury. Studies examining the effect of insurance status on care of the injured child have similarly uncovered unsettling inequities. Disparities in delivery of pediatric trauma care have been identified based on access to pediatric trauma centers. Other studies have sought to reduce disparities by use of guidelines. Finally, prevention studies have demonstrated racial disparities in the use of motor vehicle restraints, with improved restraint use in minority populations after implementation of culturally tailored prevention programs.
The cause of disparities in childhood trauma appears to be multifactorial and may include race, socioeconomic factors, insurance status, access, and healthcare provider biases. Multiple studies have confirmed that disparities exist, but it is difficult to tease out the reasons why they exist. Further work is necessary to identify causes of such disparities and formulate strategies to eliminate them.
本综述的目的是强调最近在理解儿科创伤的流行病学以及健康差异对受伤儿童护理的影响方面的进展。
最近研究表明，与白人儿童相比，少数族裔儿童的创伤后临床和功能结局更差，非裔美国人种族是死亡率的独立预测因素。尽管控制了伤害严重程度和保险状况（作为社会经济地位的替代指标），但这些差异仍然存在。在比较全国数据与创伤性脑损伤儿童的本地机构数据时，也发现了死亡率方面的显著种族差异。研究检查保险状况对受伤儿童护理的影响，也发现了令人不安的不平等现象。根据能否获得儿科创伤中心，确定了儿科创伤护理的差异。其他研究试图通过使用指南来减少差异。最后，预防研究表明，在使用汽车安全带方面存在种族差异，在实施了针对特定文化的预防计划后，少数族裔人群的安全带使用率有所提高。
儿童创伤中存在差异的原因似乎是多方面的，可能包括种族、社会经济因素、保险状况、可及性和医疗保健提供者偏见。多项研究证实存在差异，但很难确定其存在的原因。需要进一步努力确定造成这些差异的原因，并制定消除这些差异的策略。
