Pediatric Trauma Mortality Differs by Neighborhood Opportunity Level.

OBJECTIVE

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).

METHODS

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).

RESULTS

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).

CONCLUSION

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 OF EVIDENCE

Level III.