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Injury Epidemiology

, 2:32

First Online: 11 December 2015Received: 16 September 2015Accepted: 18 November 2015DOI: 10.1186-s40621-015-0063-2

Cite this article as: Leonhard, M.J., Wright, D.A., Fu, R. et al. Inj. Epidemiol. 2015 2: 32. doi:10.1186-s40621-015-0063-2

Abstract

BackgroundTraumatic brain injury TBI greatly contributes to morbidity and mortality in the pediatric population. We examined potential urban-rural disparities in mortality amongst Oregon pediatric patients with TBI treated in trauma hospitals.

MethodsWe conducted a retrospective study of children ages 0–19 using the Oregon Trauma Registry for years 2009–2012. Geographic location of injury was classified using the National Center for Health Statistics Urban-Rural Classification Scheme. Incidence rates were calculated using Census data for denominators. Associations between urban-rural injury location and mortality were assessed using multivariable logistic regression, controlling for potential confounders. Generalized estimating equations were used to help account for clustering of data within hospitals.

ResultsOf 2794 pediatric patients with TBI, 46.6 % were injured in large metropolitan locations, 24.8 % in medium-small metropolitan locations, and 28.6 % in non-metropolitan rural locations. Children with rural locations of injury had a greater annualized TBI incidence rate, at 107-100,000 children per year, than those from large metropolitan areas 71-100,000 per year. Compared to children injured in urban locations, those in rural locations had more than twice the crude odds of mortality odds ratio OR, 2.5; 95 % CI, 1.6–4.0. This association remained significant OR, 1.8; 95 % CI, 1.04–3.3 while adjusting for age, gender, race, insurance status, injury severity, and type of TBI blunt vs. penetrating.

ConclusionWe observed higher rates of TBI and greater proportions of severe injury in rural compared to urban areas in Oregon. Rural children treated in the trauma system for TBI were more likely to die than urban children after controlling for demographic and injury factors associated with urban-rural residence. Further research is needed to examine treatment disparities by urban-rural location. Future work should also identify interventions that can reduce risk of TBI and TBI-related mortality among children, particularly those who live in rural areas.

KeywordsTraumatic brain injury Pediatric Urban Rural Health disparities AbbreviationsCDCCenters for Disease Control and Prevention

CIConfidence interval

E-codeExternal cause of injury code

EDEmergency department

GCSGlasgow Coma Scale

GEEGeneralized estimating equations

ICD-9-CMInternational Classification of Diseases, 9th Revision, Clinical Modification

ISSInjury Severity Score

LOSLength of stay

MVCMotor vehicle collision

NCHSNational Center for Health Statistics

OHAOregon Health Authority

OROdds ratio

TBITraumatic brain injury

USUnited States

Electronic supplementary materialThe online version of this article doi:10.1186-s40621-015-0063-2 contains supplementary material, which is available to authorized users.

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Autor: Megan J. Leonhard - Dagan A. Wright - Rongwei Fu - David P. Lehrfeld - Kathleen F. Carlson

Fuente: https://link.springer.com/







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