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Abstract
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BACKGROUND: Traumatic injuries are significant sources of morbidity and mortality in the pediatric population. Using a national database, this study aims to characterize pediatric facial fracture management and the effect of healthcare policy changes on populations receiving treatment.
METHODS: A retrospective cohort study was performed using HCUP KID databases from 2000-2016. Pediatric patients admitted with a facial fracture diagnosis were included. Clinical outcomes include mortality, reduction of fracture during hospital stay, and open fracture reduction. The impact of the Affordable Care Act (ACA) on patient demographics and management was assessed.
RESULTS: Between 2000-2016, 82,414 patients were managed for facial fractures, 8.3% of whom were managed after implementation of the ACA (6841). Mean age was 15.2, with a male:female ratio of 2.9:1. Significant racial disparities were identified before the ACA: African American and Native American patients had decreased odds of having facial fracture reduction during the initial hospital stay (OR 0.84, 0.86), and identifying as either Hispanic or Native American was associated with higher odds of mortality (OR 1.4, 2.4). Race was not contributory to patient mortality after the ACA. Prior to ACA implementation, patients receiving care with no charge (including charity care/charity research) had lower odds of having an open reduction or any reduction; insurance status was not contributory to management after the ACA.
CONCLUSIONS: Although the ACA may have increased access to care for certain populations, race- and gender-associated differences in mortality rate and fracture management should be further investigated to ensure a national standard of equitable patient care.
Language: en |