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Pediatric Hand Trauma in Underserved Populations
Meeti Mehta, BS; Anne E. Glenney, BA; Alexander J. Davit, MD
University of Pittsburgh School of Medicine
2023-02-10
Presenter: Meeti Mehta
Affidavit:
Meeti Mehta
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Introduction
Under-served populations including racial minorities, low-income, and rural patients, are disproportionately affected by trauma. This study describes pediatric hand injuries in these groups and assesses their risk of injury.
Methods
This was a retrospective cohort of pediatric hand trauma patients from 2010-2020. Patients were stratified by race, median household income, and geography. Area Deprivation Index (ADI) was calculated and stratified by top 50% (most disadvantaged neighborhoods). Summary statistics were computed, and binomial regression was used to calculate relative risks (RR).
Results
1,311 patients were referred for hand trauma. 388 patients (29.6%) were minority race, 107 (8.2%) lived in rural locations, and 158 (12.1%) had a median annual household income < $43,000. 969 patients (73.9%) lived in neighborhoods with the top 50% ADI. Compared to urban children, rural children had greater likelihood of fingertip injuries (14% vs 1.6%, RR 8.48, CI 4.46-16.14, p<0.001). Compared to Caucasians, minority-race children had increased risk of violent (10.6% vs 2.9%, RR 3.63, CI 2.27-5.81, p<0.001) or self-inflicted injury mechanisms (4.9% vs 2.3%, RR 2.16, CI 1.18-3.98, p=0.01). Compared to children from lower ADI neighborhoods, children from top 50% ADI neighborhoods had greater risk of violent injury (6.0% vs 2.9%, RR 2.08, CI 1.08-4.03, p=0.02). No significant differences were found among children from different income levels.
Conclusions
Greater prevalence of fingertip injuries in rural children highlights the need for rural hand surgeons. Children of minority race and from disadvantaged neighborhoods had increased likelihood of violent hand trauma, representing the impact of social determinants of health.
