Social Determinants of Severe Injury Among Pediatric Patients During the COVID-19 Pandemic: An Exploratory Study.
Rebeccah L Sokol, Usha Sethuraman, Katherine Oag and 3 others
PMID 35738995WHAT IT FOUND
Among 360 children admitted to a trauma center, caregivers who needed child care and reported neighborhood violence, or who lacked health insurance, were more likely to have a child with severe injury.
This is an exploratory link, not cause.
Key findings
01In adjusted models, the pattern of child care need plus neighborhood violence was associated with severe injury (adjusted odds ratio 2.77; 95% CI 1.01-7.62).
02Caregiver lacking health insurance was associated with severe injury in the adjusted model (adjusted odds ratio 2.29; 95% CI 1.02-5.16), but not in the hierarchical model.
03The pattern of caregiver lacking social support was not associated with severe injury after demographic adjustment (adjusted odds ratio 1.53; 95% CI 0.66-3.57).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It was a convenience hospital-based sample of children already admitted to a trauma center, so it cannot say anything about children who were injured but did not seek care. The data were cross-sectional and observational, so the study cannot show that social determinants caused severe injury. The association rule analysis was exploratory and restricted to 248 patients with at least one reported negative social determinant, so the patterns may be unique to this sample. Patients with confirmed child maltreatment were excluded when legal guardians were not available to complete the questionnaire, which may miss a relevant high-risk group. The same caregiver insurance finding was not significant in the hierarchical models, so the results are not consistent across analytic approaches.
The easy way to misread this
Do not read the adjusted odds ratios as evidence that child care needs, neighborhood violence, or lack of insurance caused severe injury. This was an exploratory cross-sectional study of children already admitted to a trauma center, and it did not test whether asking about these factors changes care or prevents injury.