Pediatrics
Janet Mao, BA
Medical Student
Emory University School of Medicine
Atlanta, Georgia, United States
Enoch Leung, MD, PhD
Physician
Children's Healthcare of Atlanta
Atlanta, Georgia, United States
Janet Mao, BA
Emory University School of Medicine
Atlanta, Georgia, United States
To better understand the social determinants of health (SDoH) underlying pediatric patients diagnosed with traumatic brain injuries (TBIs) and spinal cord injuries (SCIs) secondary to gunshot wounds (GSWs) that were admitted to a Comprehensive Intensive Rehabilitation Unit (CIRU) between 2021-2024.
This study is a retrospective chart review of 73 pediatric patients who were admitted to the CIRU with GSWs. TBIs and SCIs were identified by ICD codes, diagnoses, and complaints documented during admission by PM&R. Patient demographics analyzed include age, sex, race, ethnicity, zip code, and insurance. SDoH metrics were based on Child Opportunity Index (COI) +/- Social Vulnerability Index (SVI) for patient’s zip code. 11 charts were excluded from analysis for not having TBI or SCI diagnoses as identified above.
48% of patients with GSWs were diagnosed with TBIs and 38% with SCIs. The average age of all patients was 11.5 years old, patients with TBI was 9.7 years old, and patients with SCI was 14.5 years old. 82.3% of TBI/SCI patients were male and 83.6% of TBI/SCI patients identified as Black or African American. 45.2% had Medicaid, 35.6% had a Medicaid Managed Care Plan, and 8.2% had no insurance.
Analysis of zip code-based SDoH metrics identified majority of patients had COIs categorized as “Low” to “Very Low” based on nationally normalized COIs, and SVIs greater than 0.5, indicating the most vulnerable quartiles nationally.
This study is the first pediatric study evaluating social and geographical determinants of health in the form of COIs and SVIs and their relationship to prevalence of TBIs and SCIs secondary to GSWs. Majority of admissions to the CIRU resided within geographical areas known to have lower overall COI opportunity levels and more vulnerable SVIs. The results highlight the need for further research to determine how these complex social and environmental variables impact health outcomes.
