Differences in Mortality by Race in a Cohort of Traumatically Injured Children Admitted to the Pediatric Intensive Care Unit

Background: Inequities in disease severity, healthcare delivery and health outcomes based on race are pervasive among children living in the United States (US). Several studies using death certificate data demonstrate higher mortality in traumatically injured Black children compared to traumatically injured White children. However, it is not known if there are race-based differences in mortality for critically injured children who survive to hospital admission and require care in a pediatric intensive care unit (PICU). Understanding if differential hospital-based care exists is an essential first step in eliminating healthcare disparities in this patient population. Therefore, the primary objective of this study was to use a multicenter quality-controlled database of US PICUs to describe differences in mortality based on race among traumatically injured children.

Methods: With IRB approval, the Virtual Pediatric Systems (VPS, LLC; Los Angeles, CA) database was queried to identify children <19 years of age admitted to a US PICU with traumatic injury (STAR sub-category = trauma) from 1/1/2018 to 12/31/2019. Children were categorized as White, Black, Hispanic ethnicity, Asian (including Native Hawaiian or other Pacific Islander) or Other race. Differences in patient demographics, injury characteristics, and mortality were compared across races using chi square tests.

Results: Among the 10,086 included subjects, 50.3% (n=5076) were White, 16.6% (n=1676) were Black, 21.1% (n=2126) were Hispanic ethnicity, 3.9% (n=393) were Asian, and 8.1% (n=815) were categorized as Other race. Most children suffered a brain or spine injury (n=6775, 67.2%), and 29.4% required mechanical ventilation during the hospital stay. There were differences in injury type (p < 0.001), need for mechanical ventilation (p < 0.001), and need for operative intervention (p=0.001) between races. Nearly 5% (n=460) of children died. There were differences in mortality rates across race categories (p < 0.001); Black children had the highest mortality rate (6.6%) and Asian children had the lowest mortality rate (3.1%).

Conclusion: In this cohort of trauma patients requiring PICU care, we found differences in injury type, need for mechanical ventilation, need for operative intervention, and hospital mortality based on patient race. Additional studies to understand why these differences exist are urgently needed.