(1013) Disparities in Pediatric Head and Neck Trauma Emergent Airway Management: National Trauma Data Bank Study

Introduction: Airway management is a cornerstone of pediatric trauma response and head injuries comprise a majority of severe childhood injuries. Here we assess factors informing emergent airway management in pediatric head and neck (H&N) trauma patients with Pediatric Glasgow Coma Score (GCS) under 8.

Methods: A retrospective cohort study using the National Trauma Data Bank (2007-15) of patients under 18 years old with H&N trauma and GCS under 8 was conducted. Excluded were those dead on ED arrival or with intracranial/burn injuries. Demographics, hospital characteristics and emergent airway interventions determined by ICD-9 codes on day of admission were collected. Multivariate logistic regression was performed in R.

Results: From 955,397 patients, 25,935 (2.7%) patients met inclusion criteria (66.3% male, median age 13 (IQR: 6-16)). 60% White, 17% Black, and 22% Hispanic or Latino. Common mechanisms of injury were occupant in motor vehicle accident (36%), motor vehicle pedestrian accident (12%), fall (10%), and other transportation cause (9.9%). Median Injury Severity Score (ISS) was 24 (IQR:14-33). Emergent cricothyrotomy rate was 2.6/1,000 trauma admissions compared to 746.5 for intubations.

When controlling for ISS and injury mechanism, factors increasing likelihood of emergent cricothyrotomy include age over 12 (OR 5.12 [95%CI: 2.56-12.2]) and treatment in an over 600-bed hospital (2.45 [1.27-5.47]). Compared to White patients, Black patients were less likely to receive emergent cricothyrotomy or intubation (0.64 [0.45-0.89]; 0.82 [0.75-0.91]). Hispanic or Latino patients were less likely to receive emergent cricothyrotomy (0.54 [0.34-0.86]). Compared to university hospitals, non-teaching hospitals were less likely to perform emergent intubations (0.65 [0.57-0.74]).

Conclusions: Racial and ethnic disparities exist in emergent airway management of pediatric patients with H&N trauma. Smaller and non-teaching hospitals are less likely to perform emergent airway interventions, highlighting the importance of adequate training and resources in those settings.