Department of Pediatrics, University of California, San Francisco, San Francisco, CA, 94143, USA.
Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA.
Pediatr Surg Int. 2024 Sep 27;40(1):255. doi: 10.1007/s00383-024-05840-8.
Traumatic brain injury (TBI) is a leading cause of pediatric death and disability. Abusive head trauma confers greater morbidity and mortality compared with accidental TBI. National trends reveal disproportionate involvement of minority children in the child welfare system. The study investigates socioeconomic disparities in child protective services (CPS) involvement in pediatric TBI.
Retrospective chart review was conducted for TBI patients (n = 596) admitted to an academic pediatric level I trauma center from 2015 to 2022, where institutional policy dictates automatic CPS referral for TBI patients ≤ 2 years. Analysis of variance, chi-squared, and logistic regressions compared racial and ethnic groups and calculated adjusted odds of CPS case acceptance.
Rates of non-accidental trauma, CPS involvement, insurance, and marital status differed across racial and ethnic backgrounds (p < 0.05). Of patients ≤ 2 years, Hispanic patients (OR: 0.38, 95%CI [0.16,0.91]) had decreased odds of CPS involvement compared to non-Hispanic White patients when adjusting for confounders including injury severity, injury type, and socioeconomic status.
We highlight racial and ethnic differences in incidence of pediatric TBI and CPS involvement, even in the setting of an automatic CPS referral policy for pediatric TBI patients ≤ 2 years.
创伤性脑损伤（TBI）是导致儿童死亡和残疾的主要原因。与意外 TBI 相比，虐待性头部创伤导致更高的发病率和死亡率。国家趋势表明，少数族裔儿童在儿童福利系统中的参与度不成比例。本研究调查了儿童保护服务（CPS）在儿科 TBI 中的参与度存在社会经济差异。
对 2015 年至 2022 年期间在一家学术性儿科一级创伤中心收治的 596 名 TBI 患者进行了回顾性图表审查，该机构的政策规定对≤2 岁的 TBI 患者自动进行 CPS 转介。方差分析、卡方检验和逻辑回归比较了种族和民族群体，并计算了 CPS 案例接受的调整后优势比。
非意外性创伤、CPS 参与、保险和婚姻状况在不同种族和民族背景下存在差异（p<0.05）。在≤2 岁的患者中，与非西班牙裔白人患者相比，西班牙裔患者（OR：0.38，95%CI [0.16,0.91]）的 CPS 参与率较低，调整混杂因素包括损伤严重程度、损伤类型和社会经济状况后。
即使在≤2 岁的儿科 TBI 患者自动进行 CPS 转介政策的情况下，我们也强调了儿科 TBI 和 CPS 参与的种族和民族差异。
