(1753) Child Opportunity Index Is Associated With Mortality in Critically Injured Pediatric Patients

Introduction: Injury is the leading cause of death in children. Understanding the association between social determinants of health and pediatric injury is paramount. We aimed to measure the association between Child Opportunity Index (COI) and mortality for injured patients requiring pediatric intensive care unit admission, hypothesizing that lower COI is associated with higher mortality.

Methods: This was a retrospective, multi-center, cohort study using Virtual Pediatric Systems data for injured children ( < 18 years) who were admitted to fifteen PICUs between Jan 1, 2019- Dec 31, 2020. Based on CDC injury definitions, we used proprietary VPS STAR codes to identify patients who experienced trauma, non-accidental injury, drowning, ingestion/poisoning, burn/inhalational injury, and suffocation. The association between COI and mortality was measured using logistic regression after adjusting for age, sex, language, payor, mechanism, complex chronic condition, origin of admission, and severity of illness. Given the association of race and neighborhood-level variables—due to historical red-lining of neighborhoods and structural racism—we provided adjusted models with and without race.

Results: 3778 patients were admitted to the PICU with injury, of which 235 died (mortality rate 6.2%). The distribution by COI was: 29% Very Low, 19% Low, 20% Moderate, 16% High, and 16% Very High. The sample was mostly White (47.3%) followed by Black (23%) and Hispanic or Latino (12%). Most were publicly insured (Public 57%; Private 29%; 6% Self Pay/Other). English was the most common language (90%) followed by Spanish (7%). Approximately 21% of children had a complex chronic condition. Injury was classified as Head Trauma (46%), Non-Head Trauma (20%), Non-accidental Injury (9%), Burn (3%), Drowning (4%), Ingestion (10%), Suffocation ( < 1%). Adjusted odds of mortality were higher for patients with Moderate (aOR 3.13 [1.3-8.01], p=0.01) and Very Low (aOR 3.28 [1.36-8.44], p=0.01) COI compared to Very High COI. This finding was consistent in adjusted models with and without race.

Conclusions: Very Low and Moderate COI was associated with increased mortality of injured children requiring the PICU. Further investigation is needed to identify potentially modifiable determinants of child opportunity to decrease pediatric injury.