Heather Ross, MD
CURRENT APPOINTMENTS
SPECIALTIES
LANGUAGES
PATIENT TYPE
RESEARCH INTERESTS
- Prevention efforts to reduce short and long term morbidity associated with both inflicted, and burns that are result of neglect
- Learning how efforts to maximize communication and spread of knowledge to multidisciplinary workers in child welfare could ultimately lead to better outcomes for children and families
EDUCATION INTERESTS
- Continue graduate course work in public health towards completion of a master's degree with a focus on legislative advocacy in Child Abuse policy
- Teaching medical students, residents, and fellows
- Advocacy for a more robust clinical experience in Child Abuse during Pediatric training
ASSOCIATIONS / MEMBERSHIPS
EDUCATION
RESEARCH ABSTRACT
ABSTRACT
Background: Child maltreatment is an independent risk factor for prolonged length of stay (LOS). Additionally, children admitted with non-accidental trauma have more complications, higher hospital costs, and higher mortality rates compared to children admitted with accidental trauma.
Hypothesis/Objectives: The aim of this study was to describe characteristics of children admitted for non-accidental trauma (NAT) who have prolonged LOS to identify potential targeted interventions to reduce LOS. With a focus on health disparities in the inpatient setting, this study also sought to identify racial differences in patients with prolonged LOS, including admission to the ICU as well as mortality. We hypothesized the identification of both non-modifiable and modifiable characteristics in this population, where modifiable characteristics would lead to the development of targeted interventions expected to reduce LOS.
Methods: This was a retrospective descriptive comparative study using a Level 1 Pediatric Trauma Registry to identify patients < 16 years admitted for NAT from January 2017 to May 2021. Using IBM SPSS version 27.0, we performed descriptive statistics on characteristics of children admitted with prolonged LOS (> 75th%ile. To compare categorical and continuous variables we used nonparametric tests and multivariable regression analysis to determine predictors of prolonged LOS.
Results/Conclusions: Between 2017-2021, there were 380 children hospitalized for NAT with a median LOS of 1.75 days. 96 children met the criteria for prolonged LOS, defined as >71 hours, with a median LOS of 135 hours (5.6 days). The median age of children was 6 months, 61.5% were male, and 82.3% were insured by Medicaid. 70.8% of children were White, non-Hispanic/Latino and a majority (54.2%) transferred from an outside hospital. More frequent admissions occurred on a Thursday or Friday to the Burn surgery service (14.6%) and ICU (35.4%). Of the 35.4% of children admitted to the PICU, 76.5% were White and 56% required intubation with a median LOS of 5 days. Overall mortality was 2.4%, and patients were more often young (median 6 mo), White non-Hispanic children (66.7%), and 33% had prolonged LOS. Predictors of prolonged LOS included a Thursday or Friday admission, number of ICU days, as well as the number of consultations and diagnoses. While our sample is primarily White non-Hispanic, and may not be generalizable to other centers, there was no evidence of racial disparity. However, 82.3% of our sample was insured by Medicaid, which highlights other important disparities. We adopted targeted inventions to increase the availability of skeletal surveys on weekends and a protocol to improve management of child maltreatment at outside hospitals. Further studies could evaluate other potentially modifiable factors in children admitted for NAT with prolonged LOS to develop targeted interventions and determine their effectiveness in reducing LOS.