Traumatic Injury Research

In the Denver metro area, there is a dearth of child injury prevention programs. Their existence has primarily depended on organizations whose mission aligns with community-focused, primary prevention initiatives that also possess the requisite resources and personnel. Additionally, identifying neighborhoods whose children are at disproportionate risk for preventable injuries continues to present challenges.

To address this gap in knowledge, a team from the Department of Surgery's Trauma Center and the Child Health Advocacy Institute's Injury Prevention Program at Children's Hospital Colorado hypothesized that certain metro zip codes would have higher rates of pediatric traumatic injuries and higher hospital charges resulting from treatment of such injuries. They also hypothesized that injury-related predictors within the zip codes could be identified.

To do so, the team reviewed data for all children treated for traumatic injuries at two of Denver's Level I trauma centers and mapped residence zip codes.

Methods

Trauma databases of two pediatric trauma centers, Children's Colorado (an American College of Surgeons-verified Level I Regional Pediatric Trauma Center) and Denver Health Medical Center (an ACS-verified Level II Pediatric Trauma Center) were queried for the following parameters:

• Patient ages 0-17
• Home zip code in Colorado
• Presented at trauma center between Jan. 2009 to Sept. 2013
• Evaluated in the Emergency Department or directly admitted following traumatic injury

The team later identified children whose zip codes fell within the two adjacent cities of Denver or Aurora, where 20% of the state's population live. Approximately 80% of traumatically injured children in Denver or Aurora went to one of the two hospitals featured in the study.

The team used Choropleth maps to identify outlier zip codes for pediatric traumatic injuries in the two cities. The 2010 census zip code demographics were used for comparison.

Results

There were 5,380 children treated for traumatic injuries during the study period, totaling $201 million in hospital charges.

Of the 58 fatal injuries, 26 were related to non-accidental trauma, which was the most common mechanism of fatal injury. Motor vehicle accidents accounted for most of the unintentional deaths, at 28%.

More than half of the children identified in the study lived in Aurora and Denver. The majority of the children were Caucasian males with minor injuries.

Choropleth maps identified zip codes in the metro Denver area with higher frequencies of pediatric traumatic injuries. For each injury mechanism, there were outlier zip codes with higher injury proportions. Total charges for treatments were mapped for all pediatric injuries in each zip code.

Four out of 53 zip codes accounted for 27% of all charges in the immediate metro area, while two zip codes averaged more than $1 million in charges each year for pediatric injury treatment.

The team used multivariate linear regression analysis to predict pediatric injuries by zip code plus demographic data from the US census bureau.

Higher rates of pediatric trauma injuries were found in zip codes with larger Hispanic populations, fewer owner-occupied homes, more married couples with children and higher populations.

Zip codes with larger populations had higher rates of burn injuries, auto- pedestrian injuries and sports-related injuries.

Discussion

Many of the team's findings mirrored those found in the CDC's Childhood Injury Report.

The Injury Prevention Program at Children's Colorado continues to expand its efforts with spatial analysis of injury data. For the past three years, the program has mapped Colorado Hospital Association data on emergency department visits for pediatric injuries. The program has leveraged the findings from these efforts to secure over $350,000 in external funding for neighborhood-focused injury prevention initiatives led by Children's Colorado and several community partners, including programs tackling child passenger safety, pedestrian safety, teen driver safety and Safe Routes to School.

Research has proven that the cost of treating pediatric injuries can be offset by prevention efforts. While there were some limitations to the study, the data provides a valuable technique to identify communities in need.

Conclusion

Traumatic injuries are a major source of pediatric morbidity and mortality. There are several ways to prevent these injuries but limited resources typically only allow for targeting the areas in greatest need. Mapping data from trauma registries allows public health initiatives to identify the communities where efforts should be focused. Hot spot areas were also identified with mapping and statistical analysis identified predictors of pediatric injuries.

The use of this strategy over time will help identify the best methods for injury prevention.

Published in the December 2016 issue of the Journal of Pediatric Surgery.