178 - Association between Area Deprivation Index and Rates of Operative Interventions among Pediatric Trauma Patients

Publication Number: 1167.178

Jaclyn E. Orehova, University of Colorado School of Medicine, Aurora, CO, United States; Emily K. Myers, Children’s Hospital Colorado, Aurora, CO, United States; Kaci Pickett-Nairne, University of Colorado School of Medicine, Meridian, ID, United States; Lori Silveira, University of Colorado Anschutz, Elizabeth, CO, United States; Keren Eyal, Children's Hospital Colorado, Aurora, CO, United States; Kathleen Adelgais, University of Colorado School of Medicine, Aurora, CO, United States; Shannon Acker, Children's Hospital Colorado, Aurora, CO, United States

Background: Area deprivation index (ADI) is a validated composite measure of neighborhood level disadvantage. Previous studies show variation in injury mechanisms and higher injury severity among pediatric trauma patients from more deprived neighborhoods. Despite higher injury severity, the association of ADI with frequency and type of operative intervention is not fully understood.

Objective: To examine the relationship between ADI and both the frequency and type of operative intervention among pediatric trauma patients.

Design/Methods: This is a cross-sectional study of trauma patients 0-18 years presenting between January 2024 to May 2025 to a single American College of Surgeons verified Level I Pediatric Trauma Center. Data obtained from the institutional trauma registry and electronic health record (EHR) included injuries categorized by body region and operative interventions categorized into orthopedic, neurosurgical, general, otolaryngologic, urologic, spine and endoscopic. Encounters were excluded if ADI could not be computed. Continuous variables were summarized with mean and standard deviation or medians and interquartile ranges. Categorical variables were summarized with frequencies and proportions. Group differences were tested via t-test for continuous and Chi Squared test for categorical variables. Univariable mixed effects models assessed associations between each independent variable and whether the injury resulted in an operation (yes/no). Mixed effects models accounted for multiple injuries per patient and quantified within- and between-subject variability in non-independent data. A multivariable mixed effects model was then constructed to assess each independent variable after adjustment for all others.

Results: A total of 2459 patients representing 4946 total injuries were included; 1658 (33.5%) of injuries required an operation. Distribution of operations differed across ADI quintiles ( < 0.001). Most common operations were orthopedic (47.5%), followed by neurosurgical (16.4%). Odds of receiving an operation ranged from 0.07-0.25 for all body regions when compared to injured extremities. Lower odds of an operation were observed among children from less deprived neighborhoods, a pattern consistent across analyses, with a 43% reduction in the multivariable model between quintile 1 and 5.

Conclusion(s): In a cohort of pediatric trauma patients, orthopedic operations were the most common. Likelihood of an operation was higher in children from areas with greater deprivation. Further research is needed to understand the relationship between injury severity and likelihood of operative intervention.

Table 1. Patient Demographics and Injury Profiles


Table 2. Univariable and Multivariable Analysis Between Patient and Injury Characteristics and Operative Intervention