Association between facility characteristics and hospital outcomes among children and youth with special health care needs following physical trauma.

BACKGROUND

Children and Youth with Special Health Care Needs (CYSHCN) have unique injury patterns and outcomes compared with other pediatric trauma patients. Evidence regarding trauma center characteristics' impact on outcomes is conflicting, and the special health care needs status has not been examined. This study examines the interaction between trauma facility characteristics and Special Health Care Needs (SHCN) status and how this relates to hospital outcomes following physical trauma.

METHODS

We analyzed the National Trauma Data Bank data for patients aged 1 to 18 years old from 2019 to 2022 (n=492,713). We examined hospital outcomes such as any inpatient complications, unplanned ICU admission, ICU and hospital LOS, and mortality. Mixed effects multivariable logistic and negative binomial regression models were used to estimate the interaction effects between facility characteristics and SHCN status on hospital outcomes, adjusting for patient demographics, Injury Severity Score, and Glasgow Coma Score.

FINDINGS: CYSHCN encounters in level I and level II trauma centers exhibited a significantly greater likelihood of complications, longer ICU and hospital LOS, and a higher probability of mortality compared with encounters without SHCN ( p <0.001). CYSHCN in Pediatric Trauma Centers and Adult Trauma Centers also showed a greater likelihood of complications, unplanned ICU admissions, longer ICU and hospital LOS, and a higher probability of mortality compared with non-SHCN encounters ( p <0.001). CYSHCN in nonprofit, for-profit, and larger hospitals have a greater likelihood of any complication, longer ICU and hospital LOS, and a higher probability of mortality ( p <0.001).

CONCLUSIONS

CYSHCN encounters have higher risks of adverse hospital outcomes following trauma admission compared with non-SHCN encounters. These results highlight the importance of tailored health care approaches for CYSHCN within trauma care settings, emphasizing the need for specialized protocols and resources to optimize outcomes and mitigate risks in this vulnerable population.

LEVEL OF EVIDENCE: Prognostic/Epidemiologic; Level III.