PC20. Health Disparities in Pediatric Facial Trauma

Abstract

PURPOSE: Pediatric facial fractures are a common cause of emergency department visits and hospital admissions. However, little has been published on the social determinants of health for pediatric facial fractures. This study aims to investigate the contribution socioeconomic status, race, education, household structure, English-language proficiency, and insurance status has on the management and outcomes in pediatric facial fracture patients. METHODS: A retrospective review was performed of patients under age 18 who were evaluated for facial fractures at a pediatric level I trauma center between 2006-2021. Variables studied included demographic information, CDC’s Social Vulnerability Index (SVI), injury characteristics, management, and outcomes. RESULTS: Facial fractures were diagnosed in 3334 patients; 2691 patients met inclusion criteria. A total of 18.3% were non-white, of whom 14.5% were Black. Black patients were 1.62 times more likely than white patients to present with mandibular fractures (p<0.001). Most fracture subtypes were associated with an increased SVI, unemployment, and a single parent household (p<0.0001). When controlling for fracture type, Black patients were 2.4 times more likely to receive imaging (p<0.0001) than white patients, but 0.52 times as likely to receive surgery (p<0.0001). Furthermore, Black patients were 2.2 times as likely to be uninsured as white patients (p=0.00021) and 1.5 times as likely to be lost to follow-up (p=0.00019). CONCLUSION: Our results show that race and socioeconomic status influence treatment and outcomes in pediatric facial fractures. Identifying systemic barriers that impact management and outcomes in vulnerable patients is necessary to overcome healthcare gaps and optimize clinical outcomes.