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Association Between Social Vulnerability and Hospital Re-presentation in Pediatric Motor Vehicle Collision Patients
Meagan Rosenberg, Alexander Knee, Aixa Perez Coulter, Michael V. Tirabassi
University of Massachusetts Chan Medical School-Baystate
Background: This study investigates social vulnerability index(SVI) as a tool to identify children at elevated risk for emergency department(ED) or hospital readmission following motor vehicle collisions(MVC).
Methods: An exploratory retrospective cohort study of pediatric trauma activations(age 0-15) for MVCs 1/1/2012-6/30/2022 at a level 1 trauma center was conducted. We excluded mortalities during the index admission. Patients were geocoded by discharge address and SVI determined by state-level census tract. SVI >90th percentile defined high SVI(hSVI). SVI themes (socioeconomic status(SES), household composition/disability(HCD), minority status/language(MSL), housing/transportation(HT)) were also evaluated. Outcomes included ED and hospital readmissions within 90 days post-discharge. Kaplan-Meier plots, adjusted relative risks(aRR), and 95% confidence intervals(CI) adjusted for injury severity score(ISS) were estimated using log-binomial regression.
Results: Results In total, 429 subjects were eligible with a mean(SD) age of 10(4). 122(28%) lived in hSVI areas. Patients with hSVI more often identified as Black(21% vs 8%). 90 days following discharge, 12(10%) with hSVI re-presented to the ED compared to 26(9%) (aRR=1.18;95%CI=0.61-2.29). At 90 days, 5(4%) with hSVI were re-hospitalized compared to 5(2%) (aRR=2.34;95%CI=0.68-8.04). By theme, HT had the strongest association (RR=1.71;95%CI=0.85-3.44) with 90-day ED representation, while SES and HCD had the strongest associations (RR=2.13;95%CI=0.63-7.24 and RR=2.71;95%CI=0.78-9.44, respectively) with 90-day rehospitalization.
Conclusion: We observed a positive association between hSVI and hospital re-admission. This hypothesis generating study would benefit from a larger study, however there is encouraging evidence to pursue ongoing investigation.
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