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Introduction Burn injuries are a major mechanism of trauma worldwide, caused by friction, cold, heat, radiation, chemical, or electric sources. Most often, burn injuries occur due to heat contact from hot liquids, solids, or fire, termed scald burns and flame burns, respectively. These types of injuries are complex and carry major injury and mortality risks, especially in pediatric populations. Burn trauma prevention has been a major focus in the US, with initiatives to increase public health outreach and safety measures. Unfortunately, children in socioeconomically disadvantaged situations may face these types of injuries at disproportionately higher rates, and we aim to highlight these disparities, if any, within our Florida community. Materials and methods This study was designed as a retrospective observational analysis using publicly available data from the Florida Health Community Health Assessment Resource Tool Set (CHARTS). Data was extracted for nonfatal burn injuries resulting in ED visits in the years 2018-2020. This data was limited to those ranging from 0 to 19 years old and converted to rates of burn injuries per 100,000. Sociodemographic details for each county were recorded from County Health Rankings & Roadmaps and compared with burn data in each respective county. Frequencies were generated for categorical data, and statistical analyses for burn rates and sociodemographic details were performed with a generalized linear model using a Poisson distribution and bivariate correlation for a p < 0.05. Results In Florida, the median annual burn rate per 100,000 was 136 (IQR: 96-179), with Jackson county holding the highest rate of 323 and Glades, Hardee, and Lafayette each holding a rate of 0. Of the 18 socioeconomic factors examined, a total of five were found to have no statistically significant effect on nonfatal burn injury ED visits: severe housing problems, percentage of Asians, teen births, percentage of children (<18 years) in poverty, and severe housing cost burden. The two most important factors to be found in nonfatal burn ED visits of pediatric patients were the percentage of those younger than 19 years old without health insurance and the average grade level performance of third-grader reading scores. When adjusting for the small sample size using Firth's bias-adjusted estimates and overdispersion, both reading scores and those without insurance play a significant role in pediatric burn injuries. For each increase in a single point in reading scores, the incidence rate ratio decreases by 97.1% (95% CI). For every percentage increase in children insured, there is a 28.8% decrease in pediatric burn injuries (95% CI). Conclusions This analysis highlights increased pediatric burn rates across multiple social determinants of health (SDOH) in all 67 Florida counties. The findings here demonstrate that there may continue to be a disproportionate distribution of burn rates among lower and higher sociodemographic areas. This study further highlights this trend within the Florida community, and continued research will be necessary to meet the needs of lower sociodemographic areas to improve burn rates in vulnerable populations, such as children, who are at increased risk of injury.
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A large proportion of patients with sickle cell disease (SCD) identify as Black or African American (AA). Social bias and stigma in healthcare outcomes for children with SCD are impossible to explore without considering the impact of racial/cultural identity, socioeconomic status (SES), and geography. It is important to understand the current influences of social movements, expanded health insurance coverage, and telehealth on these variables when considering healthcare outcomes for patients with SCD. The objective of this study was to determine the roles of racial identity, SES, and geography in healthcare outcomes for the pediatric population of children with SCD in the United States (US). This study is a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases utilized included Cochrane, CINHAL, Medline, and Nursing and Allied Health Collection, all accessed through the EBSCO Information Services. Studies met the following inclusion criteria: published in English, pediatric patients residing in the US, and published between 2017 and 2022. Search terms included "sickle cell" AND "pediatric", which were then combined with "minority" OR "racial" OR "rural" OR "urban" OR "poverty" OR "income" OR "socioeconomic status". The initial search yielded 635 unique articles, with 17 articles meeting full inclusion criteria. Overall, it was clear that there are examples of positive effects of race, low SES, and rural geographic location on positive health outcomes, though a large number of studies oscillated between showing negative associations or no association at all. Barriers to care for patients with SCD are multifaceted, making it difficult to isolate and analyze the impact of individual variables. Many studies demonstrated the significance of family, community, and institutional relationships as positive support for patients with SCD. This review highlights the need for additional research on the healthcare outcome benefits of patient/familial support groups aiming to bring together patients who share racial experience and SCD diagnosis regardless of SES and geography.
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Background: Mandibular fractures due to intentionally violent mechanisms represent a unique subset of facial fractures. The objective of our research is to identify how violence affects patterns of mandibular fractures and their outcomes. Methods: In this institutional review board-approved, retrospective study, we examined our institution's records for adult patients >18 years of age who presented with ≥ 1 mandibular fractures from January 2011 to January 2022. Violence was defined as trauma intended to hurt another or self. Demographics, fractures, mechanism, concomitant injuries, treatment, and complications were analyzed with Excel and SPSS statistical software. Results: A total of 692 patients were diagnosed with mandibular fractures, with 323 of these due to violence (47%). These patients of violence (POVs) had an average fracture per patient of 1.6 ± 0.7. The majority (88%) were male and African American (33%), and the average age was 34.3 ± 13.2 years. The most common violent mechanism was a punch (68%). The POVs presented with fewer concomitant injuries, were less likely to be admitted to the intensive care unit, and were more often surgically managed with open reduction than were patients of nonviolence (PONVs) (P < .01). POVs were more likely to have healing complications; though not statistically significant, this population was observed to be frequently lost to follow-up (P = .12). POVs notably had a much higher proportion of hardware exposure among complications than was seen in PONVs (23% vs 9%). Conclusions: Patients with violent fracture mechanisms may tend to be predisposed to more complications compared with patients who have nonviolent fracture mechanisms despite lesser severities due to social determinants of health. Characteristics of this patient subset may tend to cause difficulties in postoperative care and follow-up. Effective discharge instruction communication, patient outreach programs, and homelessness and drug abuse screening in this subset may help reduce healing complications.
