Association of social vulnerability and rehospitalization in pediatric motor vehicle trauma patients

Abstract

Introduction: We investigated social vulnerability index (SVI) as a tool to identify children at risk for readmission following motor vehicle collisions (MVC). Materials and Methods: An exploratory retrospective cohort study was conducted of pediatric trauma activations (age 0–15) for MVCs 1/1/2012 to 6/30/2022 at a level 1 trauma center. Eligibility included residence within our center's catchment area. Excluded were mortalities during the index admission. Patient address was geocoded and linked with state-level census tract SVI. Per the CDC, SVI ≥90th percentile defined high vulnerability. We evaluated SVI theme: socioeconomic status (SES), household composition and disability (HCD), minority status and language (MSL), housing and transportation (HT). Outcomes included emergency department (ED) visits and re-hospitalization within 90 days of discharge. Kaplan-Meier plots, relative risk (aRR), and 95 % confidence intervals (95 %CI) adjusted for injury severity score (ISS) were estimated using log-binomial regression. Results: Of 429 eligible subjects, 122 (28 %) resided in high SVI communities. High SVI patients had slightly higher mean ISS (8.6 vs 7.5). There was a similar risk of ED re-presentation across SVI groups (aRR=1.18; 95 %CI 0.61–2.29). However, although estimates were unstable, there was a possibility of increased risk of re-hospitalization among the high SVI group (aRR=2.34; 95 %CI 0.68–8.04). By theme, HT had the strongest association (aRR=1.71) for ED representation, whereas SES and HCD had the strongest associations for rehospitalization (aRR=2.03, 2.66, respectively). Conclusion: We observed possible associations between high SVI and higher rates of re-hospitalization. Future research with a larger sample may clarify associations. Level of Evidence: Level IV; Prognosis Study.

Keywords

• Social vulnerability index
• Trauma
• Readmission
• Motor vehicle collision
• Pediatric