Kwon Eustina G, Herrera-Escobar Juan P, Bulger Eileen M, Rice-Townsend Samuel E, Nehra Deepika
From the Department of General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Ann Surg Open. 2023 May 31;4(2):e287. doi: 10.1097/AS9.0000000000000287. eCollection 2023 Jun.
To describe adolescent injuries by the community-level social vulnerability, focusing on injuries related to interpersonal violence.
The Center for Disease Control and Prevention's social vulnerability index (SVI) is a tool used to characterize community-level vulnerability.
Injured adolescent trauma patients (13-17 years old) cared for at a large Level I trauma center over a 10-year period were identified. Injuries were classified by intent as either intentional or unintentional. Census tract level SVI was calculated by composite score and for 4 subindex scores (socioeconomic, household composition/disability, minority/language, housing type/transportation). Patients were stratified by SVI quartile with the lowest quartile designated as low-, the middle two quartiles as average-, and the highest quartile as high vulnerability. The primary outcome was odds of intentional injury. Demographic and injury characteristics were compared by SVI and intent. Multivariable logistic regression was used to estimate the adjusted odds of intentional injury associated with SVI.
A total of 1993 injured adolescent patients (1676 unintentional and 317 intentional) were included. The composite SVI was higher in the intentional injury cohort (mean, SD: 66.7, 27.8 vs. 50.5, 30.2; < 0.001) as was each subindex SVI. The high SVI cohort comprised 31% of the study population, 49% of intentional injuries, and 51% of deaths. The high SVI cohort had significantly increased unadjusted (odds ratio, 4.5; 95% confidence interval, 3.0-6.6) and adjusted (odds ratio, 1.8; 95% confidence interval, 1.6-2.8) odds of intentional injury.
Adolescents living in the highest SVI areas experience significantly higher odds of intentional injury. SVI and SVI subindex details may provide direction for community-level interventions to decrease the impact of violent injury among adolescents.
根据社区层面的社会脆弱性描述青少年受伤情况，重点关注与人际暴力相关的伤害。
疾病控制与预防中心的社会脆弱性指数（SVI）是一种用于描述社区层面脆弱性的工具。
确定在一家大型一级创伤中心接受治疗的10年间受伤的青少年创伤患者（13 - 17岁）。伤害按意图分为故意或非故意。通过综合评分以及4个分项指数评分（社会经济、家庭构成/残疾、少数族裔/语言、住房类型/交通）计算普查区层面的SVI。患者按SVI四分位数分层，最低四分位数指定为低脆弱性，中间两个四分位数为平均脆弱性，最高四分位数为高脆弱性。主要结局是故意受伤的几率。通过SVI和意图比较人口统计学和伤害特征。使用多变量逻辑回归估计与SVI相关的故意受伤的调整几率。
共纳入1993名受伤青少年患者（1676名非故意受伤和317名故意受伤）。故意受伤队列中的综合SVI更高（均值，标准差：66.7，27.8对50.5，30.2；<0.001），各分项指数SVI也是如此。高SVI队列占研究人群的31%，故意受伤的49%，死亡的51%。高SVI队列未经调整的故意受伤几率显著增加（优势比，4.5；95%置信区间，3.0 - 6.6），调整后的几率也增加（优势比，1.8；95%置信区间，1.6 - 2.8）。
生活在SVI最高地区的青少年故意受伤的几率显著更高。SVI及其分项指数细节可为社区层面的干预措施提供方向，以减少暴力伤害对青少年的影响。
