Does Race and Insurance Status Play a Role in High-Grade Renal Trauma in the Pediatric Population? - An Analysis from the Traumatic Renal Injury Collaborative in Kids (TRICK) consortium
Albert S T Lee, DO, PharmD1, Ching Man Carmen Tong, DO2, Jacob W. Lucas, DO3, Vinaya P. Bhatia, MD4, Daniel Mecca, MD5, Benjamin Abelson, MD6, Jeffrey Ellis, MD3, Soo Kim, MD4, Xiaoyi Zhuo, MD4, Jonathan Gerber, MD4, Douglass B. Clayton, MD6, Kirstin Simmons, BS6, Gabriella Crane, MD6, Harold N. Lovvorn, MD6, Madhushree Zope, MD7, Pankaj P. Dangle, MD2, Robert T. Russell, MD2, Sumit Singh, MD2, Christopher J. Long, MD8, Dana Weiss, MD8, Ming-Hsien Wang, MD4, Daniel Casella, MD1, Christina Ho, MD1.
1Children's National Hospital, Washington, DC, USA, 2University of Alabama, Birmingham, AL, USA, 3Einstein Healthcare Network, Philadelphia, PA, USA, 4Texas Children’s Hospital, Houston, TX, USA, 5Walter Reed National Military Medical Center, Bethesda, MD, USA, 6Monroe Carell Jr. Children’s Hospital at Vanderbilt University Medical Center, Nashville, TN, USA, 7Baylor College of Medicine, Houston, TX, USA, 8Children’s Hospital of Philadelphia, Philadelphia, PA, USA.
BACKGROUND: Healthcare disparities have been shown to impact outcomes in adult renal trauma. We sought to examine the impact of race and insurance status on the presentation, management, and outcomes of high grade renal trauma in a large pediatric high grade renal trauma registry.
METHODS: A retrospective cohort study of a large, multi-center registry of high grade pediatric renal trauma was performed. Pediatric trauma patients who were<18 years of age with high grade renal traumas (grades III, IV, and V according to the 2011 American Association of Surgical trauma classification) from 2007-2020 were included. Patient demographics, presenting characteristics, hospital courses, outcomes and follow-ups were extracted and compared using one-way ANOVA or Kruskal-Wallis test for continuous data and Chi-square test or Fisher’s exact test for binary or categorical data. P< 0.05 was considered statistically significant.
RESULTS: A total of 345 patients were identified. Thirty-six with unknown race or insurance status were removed from the analysis. 205 (66.3%) were Caucasian, 85 (27.5%) were African American (AA), and 19 (6.1%) were Other races. 135 (43.7%) had public insurance,154 (49.8%) had private insurance and 20 (6.5%) were self-pay. Impact of Race: Compared to Caucasian patients, AA patients have higher rates of penetrating injury. Additionally, those with Other and AA races presented at a younger age than those with Caucasian races. However, no differences were found between race groups in the rate of operative procedure performed, ICU admission, complications or mortality (see Table 1). Impact of Insurance status: While those with public insurance presented with higher injury severity scores, and higher rates of bowel injury and blood transfusion, no differences were found between groups in the rate of operative procedure performed, ICU admission or complications. Those with private insurance had higher rate of Urology follow up after discharge(see Table 2).
CONCLUSIONS: Socioeconomic status has an influence on the mechanism of injury, transfusion rate and urology follow-up rate; however, it does not influence rates of surgical intervention, post-injury complications or mortality. This is contrary to findings in adult renal trauma and highlights the differences between adult and pediatric populations and the need for dedicated renal trauma guidelines for the pediatric population. 
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