O'Guinn MaKayla L, Ginther Anna, Ourshalimian Shadassa, Spurrier Ryan G, Chaudhari Pradip P
Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.
Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.
J Pediatr Surg. 2025 Jan;60(1):161950. doi: 10.1016/j.jpedsurg.2024.161950. Epub 2024 Sep 21.
Traumatic injuries are a leading cause of death in children and a child's neighborhood characteristics can be a risk factor. Our objective was to describe the association between pediatric trauma mortality and Child Opportunity Index (COI).
A multicenter, retrospective cross-sectional study was conducted across 15 trauma centers from 2010 to 2021 within a large metropolitan county to evaluate trauma activation mortalities involving children <18 years-old. We examined clinical and demographic data from the county trauma registry and linked home zip code to COI, a measure of neighborhood level resources critical for children's development. Proportion of mortalities were compared to the proportion of children within each COI quintile and injury mechanism was evaluated across COI quintile. Analysis was performed using Kruskal-Wallis and chi-square tests (α = 0.05).
Of 31,702 pediatric trauma activations, 513 (1.6%) mortalities occurred. Mortalities mostly resulted from assaults (37.0%), pedestrian injuries (26.7%), and motor-vehicle collisions (18.7%). Of all mortalities, 32.6% were firearm related, either from an assault or self-inflicted. A greater proportion of mortalities were children from very low (47.6%) and low (20.9%) COI neighborhoods with fewer from higher (8.8.% and 7.6%) COI-neighborhoods compared to the county's proportion of children within these quintiles (p < 0.001). The injury mechanisms were different, with mortalities of lower COI neighborhoods being associated with assaults (p = 0.005), while mortalities of higher COI neighborhoods were self-inflicted (p = 0.003).
Lower opportunity neighborhoods had a higher incidence of pediatric trauma mortality. Mortality mechanism varied across neighborhoods with assault greater in lower opportunity neighborhoods and self-inflicted among higher opportunity neighborhoods.
Level III.
创伤性损伤是儿童死亡的主要原因，儿童所在社区的特征可能是一个风险因素。我们的目的是描述儿童创伤死亡率与儿童机会指数（COI）之间的关联。
2010年至2021年期间，在一个大都市县的15个创伤中心进行了一项多中心回顾性横断面研究，以评估涉及18岁以下儿童的创伤激活死亡率。我们检查了县创伤登记处的临床和人口数据，并将家庭邮政编码与COI相关联，COI是衡量对儿童发展至关重要的社区层面资源的指标。将死亡率比例与每个COI五分位数内的儿童比例进行比较，并评估COI五分位数内的损伤机制。使用Kruskal-Wallis检验和卡方检验进行分析（α = 0.05）。
在31702例儿童创伤激活病例中，513例（1.6%）死亡。死亡主要由袭击（37.0%）、行人受伤（26.7%）和机动车碰撞（18.7%）导致。在所有死亡病例中，32.6%与枪支有关，要么是袭击所致，要么是自我伤害。与该县这些五分位数内儿童的比例相比，来自极低（47.6%）和低（20.9%）COI社区的死亡儿童比例更高，来自高（8.8.%和7.6%）COI社区的死亡儿童比例更低（p < 0.001）。损伤机制不同，低COI社区的死亡与袭击有关（p = 0.005），而高COI社区的死亡是自我伤害所致（p = 0.003）。
机会较低的社区儿童创伤死亡率较高。不同社区的死亡机制各不相同，机会较低的社区袭击导致的死亡更多，而机会较高的社区自我伤害导致的死亡更多。
三级。
