184 - Disparities in Pediatric TBI Outcome and CPS Involvement

Poster Number: 184
Publication Number: 184.1355

Background: Traumatic Brain Injury (TBI) is a leading cause of pediatric death and disability. With pediatric TBI, abusive head trauma confers greater morbidity and mortality compared with accidental TBI. Reports are made to Child Protective Services (CPS) for suspected child abuse or neglect; however, national trends reveal disproportionate involvement of minority children in the child welfare system.

Objective: The study investigates socioeconomic disparities in pediatric TBI outcomes and CPS involvement.

Design/Methods: Retrospective chart review was conducted for pediatric TBI patients (n=596) admitted to an academic pediatric level I trauma center from 2015-2022, where institutional policy dictates automatic CPS referral for patients aged ≤ 2 years. Socioeconomic status indicators included: insurance status, median ZIP-code income, and parental marital status. Outcomes measured were CPS involvement, and death and disability. Analysis of variance, chi-squared, and logistic regressions with adjusted odds ratios were used to analyze data.

Results: Fifty-nine percent of patients were non-Hispanic White, 8% non-Hispanic Black, 20% Hispanic, 7% other, and 7% unknown (p-value < 0.001). Rates of non-accidental trauma, GCS, insurance, and marital status significantly differed across racial/ethnic groups. Thirty percent of TBI cases were accepted by CPS. Of patients aged ≤ 2 years, Hispanic patients (OR:0.40, 95%CI [0.17,0.95]) had decreased odds of CPS involvement. Of patients aged > 2 years, married parents (OR:0.31, 95%CI [0.14,0.66]) were associated with decreased odds of CPS involvement when adjusting for confounders including injury severity, injury type, and socioeconomic status. Female patients (OR:1.97, 95%CI [1.02,3.80]; OR:1.99, 95%CI [1.08,3.69]) had increased odds of CPS involvement in both age groups. Hispanic patients (OR:4.31, 95%CI [1.25,14.88]) had increased odds of death or disability when adjusting for confounders including injury severity, injury type, CPS involvement, and socioeconomic factors.

Conclusion(s): Differences in TBI presentation and incidence of abusive head trauma were found across racial/ethnic groups. We highlight racial/ethnic and sex differences in CPS involvement, and racial/ethnic disparities in death and disability post-TBI even in the setting of an automatic CPS referral policy.