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Pediatric Hand Trauma in Under-served Populations: a cohort study
Brodie Parent, MD MS; Chelsey Johnson, MD; Erin Anstadt; Jennifer Fantuzzo, BS; James Fisher, MS PhD; John Fowler, MD; Alexander Davit, MD
University of Pittsburgh Department of Plastic Surgery
2020-01-18
Presenter: Brodie Parent
Affidavit:
This represents the resident's own work in the following aspects: project conception and design, data collection, data analysis and interpretation, and drafting of the abstract.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Introduction:
Under-served populations are disproportionately affected by trauma, and include racial minority, low-income, and rural patients. This study describes pediatric hand injuries in these groups, and assesses their risk of injury and subsequent operations.
Methods:
This retrospective cohort study included all pediatric patients with hand injuries who were referred to our hand clinic from 2014-2019. Patients were stratified by race, household income, and geography. Charts were abstracted, and Poisson regression was used to compute relative risks (RR) with 95% confidence intervals (CI).
Results:
850 patients were referred for hand trauma. The median age was 11.4 years. 299 patients (35%) were female, 250 (29%) were a minority race, 119 (14%) lived in rural locations, and 207 (24%) had a median annual household income < $43,000. Compared to urban children, rural children were more likely to have open fractures (19% vs 11%, RR 1.1, CI 1.0-1.2, p=0.01) and tendon injuries (9% vs 4%, RR 2.5, CI 1.3-4.9, p=0.01). Compared to Caucasians, children of minority race were less likely to undergo an operation for hand trauma (11% vs 17%, RR 0.7, CI 0.4-0.9, p=0.04). No differences were found when comparing children from different income levels.
Conclusions:
Relative to urban children, rural children were more likely to have severe injuries which require operative management, highlighting the ongoing need for rural hand surgeons. Minority race children were less likely to receive an operation compared to their Caucasian counterparts, despite no apparent differences in their hand injury characteristics. This may represent systemic barriers to health-care access.
