606 - Children Presenting with Traumatic Head Injuries: The Correlation Amongst Lower Socioeconomic Status and Abuse-Associated Diagnoses

Poster Number: 606
Publication Number: 606.104

Megan Bivins, Le Bonheur/UTHSC, Germantown, TN, United States; Jeffrey C. Winer, Le Bonheur Children's Hospital, Germantown, TN, United States

Background: Racial and ethnic disparities have been widely documented in the literature pertaining to the evaluation and diagnosis of pediatric abusive head trauma (AHT).^1,2 However, Rosenthal et al found that household income is the factor most strongly associated with all categories of child abuse.³ When controlling for socioeconomic status (SES), the rates of child abuse between white children and those of minoritized racial and ethnic groups becomes insignificant.³ However, the cohort of children who have sustained head injuries and received any abuse-associated diagnoses (ARD) with stratification of median income by zip code has not been well-examined.

Objective: The objective of this study is to demonstrate a correlation in the occurrence of any abuse-associated diagnoses (ARD) versus Median Income by Zip Code Quintile & Child Opportunity Index (COI) when evaluating pediatric patients (Age 1-24 months) hospitalized with significant head injury.

Design/Methods: Utilizing the Pediatric Health Information System (PHIS) database, a retrospective analysis was conducted of children admitted with a traumatic head injury diagnosis. Included patients were those ages 1-24 months, admitted from January 1, 2018 – December 31, 2021 with a traumatic head injury diagnosis. Demographic characteristics were summarized by patient counts and percentages, stratified by the existence of any ARD. Chi-square testing was performed to identify statistical associations between patient characteristics and existence of any ARD. A significance level of 0.05 was used for all hypothesis testing. Associations were assessed using logistic regression and summarized by odds ratio and 95% confidence intervals.

Results: In review of the PHIS database, 56% of children admitted/observed for traumatic head injuries were six months or less in age. The prevalence of ARD across all ages (1-24 months) was 30.4%. As demonstrated in Figure 1, there is high variation among pediatric hospitals in the percentage of abuse diagnoses. Patients with Government insurance had 2.91 (95% CI, 2.61-3.25) times higher odds of an abuse diagnosis than those with Commercial insurance. Higher median income by zip code quintile was associated with a lower prevalence of abuse diagnoses (5th Quintile vs. 1st Quintile Median Income-adjusted odds ratio of 0.63 [95% CI, 0.52-0.76]).

Conclusion(s): Pediatric patients with government insurance or from lower median income zip codes, presenting with traumatic head injuries, are more likely to receive a diagnosis of abuse. Further work is needed to determine whether this disproportion is due to socioeconomic disparity.