The Association of Race, Sex, and Insurance With Transfer From Adult to Pediatric Trauma Centers.

Szczegóły
Abstrakt

Tytuł:: The Association of Race, Sex, and Insurance With Transfer From Adult to Pediatric Trauma Centers.
Autorzy:: Kulaylat AN; From the Departments of Surgery.
Hollenbeak CS
Armen SB; From the Departments of Surgery.
Cilley RE; From the Departments of Surgery.
Engbrecht BW; Division of Pediatric Surgery, Peyton Manning Children's Hospital, Indianapolis, IN.
Źródło:: Pediatric emergency care [Pediatr Emerg Care] 2021 Dec 01; Vol. 37 (12), pp. e1623-e1630.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Baltimore, Md. : Williams & Wilkins, [c1985-
MeSH Terms:: Insurance*
Wounds and Injuries*/epidemiology
Wounds and Injuries*/therapy
Adult ; Child ; Female ; Humans ; Injury Severity Score ; Odds Ratio ; Outcome Assessment, Health Care ; Patient Transfer ; Retrospective Studies ; Trauma Centers
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Entry Date(s):: Date Created: 20200623 Date Completed: 20211217 Latest Revision: 20231003
Update Code:: 20240105
DOI:: 10.1097/PEC.0000000000002137
PMID:: 32569252
: Czasopismo naukowe

Objective: Our objective was to investigate whether racial/ethnic-based or payer-based disparities existed in the transfer practices of pediatric trauma patients from adult trauma center (ATC) to pediatric trauma center (PTC) in Pennsylvania.
Methods: Data on trauma patients aged 14 years or less initially evaluated at level I and II ATC were obtained from the Pennsylvania Trauma Outcome Study (2008-2012) (n = 3446). Generalized estimating equations regression analyses were used to evaluate predictors of subsequent transfer controlling for confounders and clustering. Recent literature has described racial and socioeconomic disparities in outcomes such as mortality after trauma; it is unknown whether these factors also influence the likelihood of subsequent interfacility transfer between ATC and PTC.
Results: Patients identified as nonwhite comprised 36.1% of the study population. Those without insurance comprised 9.9% of the population. There were 2790 patients (77.4%) who were subsequently transferred. Nonwhite race (odds ratio [OR], 4.3), female sex (OR, 1.3), and lack of insurance (OR, 2.3) were associated with interfacility transfer. Additional factors were identified influencing likelihood of transfer (increased odds: younger age, intubated status, cranial, orthopedic, and solid organ injury; decreased odds: operative intervention at the initial trauma center) (P < 0.05 for all).
Conclusions: Although we assume that a desire for specialized care is the primary reason for transfer of injured children to PTCs, our analysis demonstrates that race, female sex, and lack of insurance are also associated with transfers from ATCs to PTCs for children younger than 15 years in Pennsylvania. Further research is needed to understand the basis of these health care disparities and their impact.
Competing Interests: Disclosure: The authors declare no conflict of interest.
(Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

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