545 - Spinal Cord Injury in U.S Children.: Emergency Department Visits, Hospital Outcomes and Resource Use

Publication Number: 1524.545

FOLAFOLUWA ODETOLA, University of Michigan Medical School, ANN ARBOR, MI, United States; Acham Gebremariam, University of Michigan Medical School, Ann Arbor, MI, United States

Background: Trauma is a leading cause of child mortality and morbidity in the U.S. There is a paucity of recent data on the triage of children with spinal cord injury (SCI) to definitive trauma care and associated clinical outcomes and resource utilization.

Objective: To describe recent patterns of emergency department (ED) evaluation and subsequent hospitalization for pediatric SCI in the U.S. and test the hypothesis that outcomes will be worse at non-trauma centers (NTC) than trauma centers (TC).

Design/Methods: Retrospective study of children 0-20 years old evaluated for SCI at U.S. EDs and either hospitalized or released, in 2016 – 2022, using the Nationwide Emergency Department Sample. Multivariable regression models assessed the relationship between the hospital TC status and in-hospital outcomes of mortality, length of stay (LOS), and overall charges, with adjustment for injury severity and other potential confounders.

Results: Of estimated 20,936 pediatric visits to the ED nationally for SCI during the study period, 77% were to TC. Boys comprised 60% of the visits, and most (89%) visits involved patients older than 10 years of age. Injuries were most often caused by motor vehicle accidents, falls, and non-motor vehicle transport accidents. The South census region had the most ED visits and subsequent hospitalizations. Most (89%) major injuries (injury severity score >15) were evaluated at TC EDs, and more visits to TC versus NTC (58% vs 5%, p < 0.01), resulted in hospitalization. Among estimated 9,617 SCI hospitalizations from the ED, 97% were to TC, with associated higher use of invasive medical devices, higher unadjusted mortality (3.9 vs 2.3%, p< 0.01), longer unadjusted mean hospital stay (9.4 vs 4.6 days, p< 0.01) and higher hospital charges (208,884 vs 123,318, p < 0.01) than NTC. Multivariable regression revealed statistically similar adjusted mortality (Odds Ratio: 0.59; 95% Confidence Interval [CI] 0.27,1.33; p = 0.20) and incremental hospital charges (-$10690.08; 95% CI: -$38,854, 17,474; p = 0.46) at TC and NTC, while LOS (Incidence Rate Ratio:1.39; 95%CI: 1.15,1.69; p < 0.01) was higher at TC.

Conclusion(s): Significant demographic and geographical variation exists in national patterns of hospital care for pediatric SCI. Despite disproportionately higher burden of severely injured patients and concomitant use of medical technology, TC had similar adjusted mortality and overall hospital charges to NTC. The study findings highlight important opportunities for further research into approaches to mitigate pediatric SCI and enhance quality of care factors that might influence clinical outcomes.