13113

Are There Racial/Ethnic Disparitie In the Use of Restrains and Outcomes In Children Following Motor Vehicle Crashes?

Saturday, October 15, 2011: 1:24 PM
205 (Boston Convention and Exhibition Center)
Rebecca Stark, MD1, Arezou Yaghoubian, MD1, Amy Kaji, MD, PHD2 and Steven L. Lee, MD1, (1)Surgery, Harbor-UCLA, Torrance, CA, (2)Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA

Purpose: Although motor vehicle crashes (MVC) are the leading cause of death among children, there is a paucity of data regarding racial/ethnic differences in injury severity score (ISS), use of restraints, and outcomes.  This study determines whether racial disparities exist in pediatric MVC passengers. 

Methods: A review of all pediatric passengers (<16 years) involved in MVCs from the National Trauma Database from 2002-06 was performed. The main outcome measures were the need for emergency surgery, morbidity, mortality, and length of stay (LOS).  The independent variables included race/ethnicity, age, gender, ISS, Glasgow coma scale (GCS), and use of restraints.

Results: 37,375 patients were identified; median age = 10 (IQR 5-14) years and 59% were male (See Table).  Overall, 45.7% of patients were restrained, with the lowest restraint use among Blacks, Hispanics, and Native Americans. 12.6% required an emergency operation, overall morbidity was 6.7%, and mortality was 5.8%.  On multivariable analysis, Blacks, Hispanics, and Native Americans were less likely to need an emergency operation and Asians were more likely to have a complication compared to Whites.  However, race/ethnicity did not affect mortality or LOS.  Higher ISS was associated with increased need for emergency operation, higher morbidity and mortality, and longer LOS.  The use of restraints was associated with a lower ISS and a decreased risk for emergency surgery.  The interaction between restraint use and ISS increased the need for emergency surgery, morbidity, and LOS.

Conclusion: Less than half of pediatric passengers in this study were restrained, with the lowest rates among Blacks, Hispanics, and Native Americans. The use of restraints was associated with a lower ISS, whereas a higher ISS was associated with increased need for emergency surgery, morbidity, mortality, and LOS. These data emphasize the need for increased education in preventive measures to minimize the risk of death and injury. 

 

White

Black

Hispanic

Asian

Native American

p

Male

56.3%

60.9%

64.7%

58.4%

58.5%

<0.0001

Age- years (IQR)

11 (6-14)

9 (5-13)

9 (4-13)

10 (5-14)

10 (4-14)

<0.0001

Restraint Use

48.8%

39.5%

39.0%

59.3%

36.8%

<0.0001

ISS (IQR)

9 (4-17)

9 (4-17)

9 (3-17)

5 (1-16)

6 (3-14)

<0.0001

ISS ≥ 15

30.0%

26.4%

28.0%

24.2%

22.8%

<0.0001

Surgery

13.5%

10.9%

12.9%

6.0%

4.3%

<0.0001

Mortality

5.8%

5.8%

5.2%

2.9%

4.3%

<0.0001

LOS-days (IQR)

2 (1-6)

2 (1-6)

2 (1-5)

1 (0-4)

2 (1-4)

<0.0001