New England Surgical Society

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Neighborhood Risk: Socioeconomic Status and Hospital Admission for Pediatric Burn Patients in Rhode Island
*Mary A Palilonis1, *Lauren Schlichting2, *Michelle L Rogers2, David T Harrington1, *Patrick M Vivier2
1Brown University/Rhode Island Hospital, Providence, RI;2Hassenfeld Child Health Innovation Institute, Providence, RI

Objective: To evaluate the association between socioeconomic status and the likelihood of admission for Emergency Department (ED) visits for pediatric burn injury in Rhode Island.
Design: A retrospective database review of pediatric ED visits from a statewide hospital system.
Setting: Most pediatric ED services in Rhode Island are provided by one hospital network, which includes the state’s only children’s hospital and burn center. This network accounts for approximately 90% of the state’s pediatric inpatient stays and more than two thirds of pediatric ED visits (unpublished data).
Patients: Patients 0-17 years old presenting to the ED for burn injury from January 1, 2005-December 31, 2014.
Main Outcome Measures: Socioeconomic status was assigned using an eight factor Neighborhood Risk Index (NRI) created from census block group data, with a higher score indicative of lower socioeconomic status. The outcome measure was ED visits admitted to inpatient care.
Results: We analyzed a sample of 1,845 pediatric ED visits for burn injuries. Most visits were discharged from the ED (88.4%) while 10.5% were admitted to inpatient care and 1.0% were transferred to another hospital. In a multivariable logistic regression, patients from high risk areas (>75th percentile NRI) had 1.58 higher odds of inpatient admission compared to patients from low risk areas (<75th percentile NRI) (95% CI: 1.08-2.30), after adjusting for age, gender, ethnicity, distance to hospital and previous ED visit for burn injury in the past 30 days.
Conclusions: Our study showed that burn injury patients from the highest risk socioeconomic areas had a higher likelihood of inpatient admission for children in Rhode Island. Further research is needed to determine what factors associated with socioeconomic status impact this finding.


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