Understanding Racial and Ethnic Variation in Pediatric Trauma Care and Outcomes

Statement of Problem

Injuries are the leading cause of death for children and adolescents, with 1 injury-related childhood death occurring every hour in the United States. In addition to mortality, injuries cause nearly 9 million visits a year by children to the emergency department. Although studies show that minority children experience higher morbidity and mortality from injuries, little is known about the reasons for such racial differences. Access to care, socioeconomic factors, patient mistrust, doctor-patient relationships, provider behaviors, and hospital factors contribute to disparities in adults. Reasons for disparities in adults cannot be directly applied to children, who differ in their ability to communicate, insurance status, and epidemiology of illnesses and injuries. Without knowledge of the sources of racial differences in pediatric trauma care and outcomes, we cannot develop effective interventions to reduce the higher morbidity and mortality among minority children. 

This project aims to understand patient, parent, provider, and system characteristics associated with racial and ethnic variation in process of care and outcome measures for injured children. We will prospectively enroll injured children admitted from The Children’s Hospital of Philadelphia emergency department to compare processes of care and outcomes of black, Hispanic, and white children. We will then survey their parents to assess culturally-based, psychosocial, and demographic characteristics and examine the association of these characteristics with racial variation in the care and outcomes of their children. We will also examine how provider characteristics, decision-making, and communication patterns affect our outcomes. Finally, we will use a national dataset to investigate the impact of healthcare system-level characteristics on pediatric injury disparities. 

Through this body of research, we hope to contribute a nuanced understanding about the extent to which known associations of race and poor injury outcomes are related to modifiable factors, such as differences in processes of care and where patients receive care. This is the critical next step in a continuum of disparities research that is expected to ultimately lead to the development and testing of interventions aimed at reducing disparities. Knowledge gained from research on injury disparities can also be applied to other conditions in pediatric emergency care. 

Suggested Citation

The Children's Hospital of Philadelphia, PolicyLab. Understanding Racial and Ethnic Variation in Pediatric Trauma Care and Outcomes [Online] Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here].