(1034) Impact of Demographic and Socioeconomic Factors on Facial Trauma Treatment Decisions

Introduction: Managing pediatric facial trauma poses many challenges and often requires a multidisciplinary approach with various specialties, including maxillofacial surgery, otolaryngology, and plastic surgery. This study aims to explore disparities in pediatric facial trauma care based on demographic and socioeconomic factors, including race and payer type.

Methods: The 2019 Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) was used to identify pediatric midface, orbit, and mandible fractures. Statistical analysis included chi squared tests and sub-group analysis with logistic regression.

Results: Database search yielded 1,220 mandible, 372 midface, and 264 orbit fractures that were surgically repaired. Chi squared analysis revealed significant racial differences in midface fracture treatment indicating a lower likelihood of surgical treatment for Black patients compared to White patients (coefficient -0.364, p = 0.031). Similarly, significant differences in treatment choice were identified in self-paying patients with orbit fractures (coefficient -0.627, p = 0.039). Logistic regression models demonstrated poor fit when considering socioeconomic and demographic factors for each facial fracture (mandible area under the curve [AUC] = 0.64; midface AUC = 0.6; orbital AUC = 0.62). In contrast, illness severity and mortality risk emerged as significant predictors of receiving surgical treatment in midface fractures (coefficient -0.886, p = 0.002, coefficient 1.203, p < 0.0001) and mandible fractures (coefficient 0.869, p = 0.002, coefficient -1.917, p < 0.0001).

Conclusions: This study offers insights into the interplay of socioeconomic, demographic, and clinical factors affecting treatment approaches for pediatric facial fractures. While race and payer type showed significant differences in treatment choices, logistic regression models exhibited poor predictive performance. The prominence of illness severity and mortality risk as significant predictors highlights the need for a nuanced understanding of decision-making in pediatric facial fracture management.