Disparities in Motor Vehicle Collision (MVC) among the Pediatric Patients

Publication Date

July 2019

Location

LSU Health Medical Education Building

Document Type

Abstract

Start Date

26-7-2019 9:00 AM

End Date

26-7-2019 12:00 PM

Description

Background: A motor vehicle collision is a collision between a vehicle and a pedestrian, animal, road debris, or another vehicle. Each year 1.25 million people lose their lives in motor vehicle collisions (MVC). An estimated 4.5 million people were severely injured in a motor vehicle collision in 2018. Motor vehicle collisions are one of the three leading causes of death in pediatric patients in the United States. The focus of this study is to discover trends in demographics, the use of protective devices, severity of injuries, surgery rates, and length of stay among pediatric patients presenting to the University Medical Center New Orleans (UMCNO) following an MVC. This study can potentially reveal disparities in MVC rates, length of stay, and imaging (X-rays, CT scans, and MRIs) practices in the care of pediatric patient sub-groups. Method: The Louisiana Trauma registry was queried for patients between birth and 18 years of age involved in an MVC meeting level 1 criteria for trauma activation at UMCNO. The charts for all patients meeting criteria were reviewed in EPIC. Variables collected included race, age, dates of admission and discharge, gender, injury severity score (ISS) and protective devices used. All data was de-identified, and then analyzed using Statistical Analysis System (SAS) 9.4. Relationships between categorical variables were assessed using Pearson’s chi-square or Fisher’s exact tests. We also performed Wilcoxon rank sum tests to compare independent groups. Result: Of the cohort of 668 pediatric patients, 435 were males and 233 were females. 403 identified as black, 218 identified as white, and the remaining 47 patients identified as neither. When analyzing by age, the two largest groups were the 13-18 year olds (302 patients) and the 4-8 year olds (155 patients). Only 20.75% of all patients studied underwent surgery. The most common surgeries were Orthopedic (61), General (47) and Neurosurgery (25). Length of stay and injury severity scores were similar for both males and females. Of the surgical patients, 11.13% were black and 9.17% were white. White patients had the highest injury severity scores (ISS) with a mean score of 11.65. All races had similar rates of x- ray imaging on day 1. There was no correlation between race and age and the number of MRIs performed. Patients in the 13-18 year age group had a higher percentage of surgeries (13.98%) (p<0.0001), longer length of stays (5 days) (p<0.0001), and the highest injury severity scores (p<0.0001). Of the 397 male patients, only 121 used seatbelts. Of the 212 female patients, only 84 used seatbelts. Conclusion: This study reveals a disparity in gender, race, and age regarding motor vehicle collisions. Black teenage males have the highest rates of level 1 trauma activations from MVCs. Although blacks are a minority in the United States, they represented more than 50% of all patients in this study. There is a wide disparity between teenage patients and patients in all other age groups regarding ISS, incidence of MVC and surgery rates. The use of a seatbelt was noted to be low across all groups, highlighting a need for more awareness and better enforcement of existing safety laws.

Comments

Mentor: Lisa Moreno-Walton MD, MS, MCR, FAAEM, UMCNO Emergency Department

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Jul 26th, 9:00 AM Jul 26th, 12:00 PM

Disparities in Motor Vehicle Collision (MVC) among the Pediatric Patients

LSU Health Medical Education Building

Background: A motor vehicle collision is a collision between a vehicle and a pedestrian, animal, road debris, or another vehicle. Each year 1.25 million people lose their lives in motor vehicle collisions (MVC). An estimated 4.5 million people were severely injured in a motor vehicle collision in 2018. Motor vehicle collisions are one of the three leading causes of death in pediatric patients in the United States. The focus of this study is to discover trends in demographics, the use of protective devices, severity of injuries, surgery rates, and length of stay among pediatric patients presenting to the University Medical Center New Orleans (UMCNO) following an MVC. This study can potentially reveal disparities in MVC rates, length of stay, and imaging (X-rays, CT scans, and MRIs) practices in the care of pediatric patient sub-groups. Method: The Louisiana Trauma registry was queried for patients between birth and 18 years of age involved in an MVC meeting level 1 criteria for trauma activation at UMCNO. The charts for all patients meeting criteria were reviewed in EPIC. Variables collected included race, age, dates of admission and discharge, gender, injury severity score (ISS) and protective devices used. All data was de-identified, and then analyzed using Statistical Analysis System (SAS) 9.4. Relationships between categorical variables were assessed using Pearson’s chi-square or Fisher’s exact tests. We also performed Wilcoxon rank sum tests to compare independent groups. Result: Of the cohort of 668 pediatric patients, 435 were males and 233 were females. 403 identified as black, 218 identified as white, and the remaining 47 patients identified as neither. When analyzing by age, the two largest groups were the 13-18 year olds (302 patients) and the 4-8 year olds (155 patients). Only 20.75% of all patients studied underwent surgery. The most common surgeries were Orthopedic (61), General (47) and Neurosurgery (25). Length of stay and injury severity scores were similar for both males and females. Of the surgical patients, 11.13% were black and 9.17% were white. White patients had the highest injury severity scores (ISS) with a mean score of 11.65. All races had similar rates of x- ray imaging on day 1. There was no correlation between race and age and the number of MRIs performed. Patients in the 13-18 year age group had a higher percentage of surgeries (13.98%) (p<0.0001), longer length of stays (5 days) (p<0.0001), and the highest injury severity scores (p<0.0001). Of the 397 male patients, only 121 used seatbelts. Of the 212 female patients, only 84 used seatbelts. Conclusion: This study reveals a disparity in gender, race, and age regarding motor vehicle collisions. Black teenage males have the highest rates of level 1 trauma activations from MVCs. Although blacks are a minority in the United States, they represented more than 50% of all patients in this study. There is a wide disparity between teenage patients and patients in all other age groups regarding ISS, incidence of MVC and surgery rates. The use of a seatbelt was noted to be low across all groups, highlighting a need for more awareness and better enforcement of existing safety laws.