The child opportunity index and disparities in non-accidental trauma screening: A single institution retrospective study

This is the authors' abstract. We don't add key points for this paper.

Background Screening patients for non-accidental trauma (NAT) often falls to physician discretion, even when published or institutional guidelines exist, and previous studies have shown disparities in screening based on patients’ race and insurance status. Objectives This study sought to evaluate NAT screening patterns at a large, urban, freestanding children's hospital to identify screening disparities. Methods Electronic Medical Record (EMR) data from 2018 to 2022 were used to identify patients under two years of age who presented to the emergency department (ED) with blunt head trauma and had abnormal imaging, to further focus the dataset on patients who were most likely to have truly experienced NAT. Patients involved in motor vehicle collisions were excluded. Abstracted variables included race, sex, age, insurance status, primary language, injury severity score (ISS) and home zip code. Screening was defined as completion of a skeletal survey. Separate multivariable logistic regressions identified disparities in screening for race and child opportunity index (COI), controlling for age, sex, and ISS. Results In the dataset, 81 (33%) patients with abnormal findings on computerized tomography (CT) of the head underwent skeletal survey. Hispanic and Black patients were more likely to be screened than White patients (OR 2.4, 95% CI: 1.1, 7.2; OR 5.2, 95% CI: 1.1, 25.4). Low COI and moderate COI groups were more likely to be screened than the high COI group (OR 3.0, 95% CI: 1.5, 6.2; OR 3.0, 95% CI: 1.3, 6.9). Conclusions Though the single-institution design of this study limits the generalizability of these trends, these findings do highlight disparities in NAT screening that exist within the studied institution and offer potential areas of improvement in the screening of at-risk children.