Jones Ruth Ellen, Babb Jacqueline, Gee Kristin M, Beres Alana L
Division of Pediatric Surgery, Department of Surgery, Children's Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 1935 Medical District Drive, D-2000, Dallas, TX, 75235, USA.
Pediatr Surg Int. 2019 Aug;35(8):869-877. doi: 10.1007/s00383-019-04491-4. Epub 2019 May 30.
Nonaccidental trauma (NAT) is a leading cause of pediatric mortality and disability. We examined our institution's experience with NAT to determine if socioeconomic status is correlated with patient outcomes.
NAT cases were reviewed retrospectively. Socioeconomic determinants included insurance status and race; outcomes included mortality, discharge disability and disposition. Correlations were identified using t test, Fisher's exact test, and logistic regression.
The cohort comprised of 337 patients, with an overall uninsured rate of 5.6%. This rate was achieved by insuring 64.7% of the cohort after admission. Non-survivors were more likely to have no insurance coverage (14.8% versus 4.8%, p = 0.041). Regression revealed that uninsured had 8 times (95% CI 1.7-38.7, p = 0.008) higher in-hospital mortality than those with insurance when controlling for injury severity. Additionally, injury severity score ≥ 15, transfer from outside hospital, need for ICU or operative treatment were predictive of mortality. Adjusted risk factors for severe disability at discharge did not include insurance status or race, while ISS ≥ 15 and ICU stay were predictive.
There are significant associations of insurance status with pediatric NAT outcomes, highlighting that determinants other than disease severity may influence mortality and morbidity. High-risk patients should be identified to develop strategies to improve outcomes.
非意外创伤（NAT）是儿童死亡和残疾的主要原因。我们研究了本机构处理NAT的经验，以确定社会经济地位是否与患者预后相关。
对NAT病例进行回顾性分析。社会经济决定因素包括保险状况和种族；预后包括死亡率、出院时的残疾情况及处置方式。采用t检验、Fisher精确检验和逻辑回归分析相关性。
该队列包括337例患者，总体未参保率为5.6%。这一比率是通过入院后为64.7%的队列患者提供保险实现的。非幸存者更有可能未参保（14.8%对4.8%，p = 0.041）。回归分析显示，在控制损伤严重程度时，未参保者的院内死亡率比参保者高8倍（95%CI 1.7 - 38.7，p = 0.008）。此外，损伤严重程度评分≥15、从外院转入、需要重症监护或手术治疗是死亡的预测因素。出院时严重残疾的校正风险因素不包括保险状况或种族，而损伤严重程度评分≥15和入住重症监护病房是预测因素。
保险状况与儿童NAT预后存在显著关联，突出表明疾病严重程度以外的决定因素可能影响死亡率和发病率。应识别高危患者以制定改善预后的策略。
