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Pediatric Trauma Surgery Patients with Higher Social Vulnerability Experience Worse Post-Surgical Outcomes

CU Department of Surgery researchers analyzed patient data to understand whether social vulnerability as associated with patients’ recovery from trauma surgery.

Written by Rachel Sauer on May 30, 2023

The Social Vulnerability Index (SVI) is an important tool that ranks each U.S. Census tract on 16 social factors – including poverty, crowded housing, and lack of vehicle access – to help identify communities and populations at greater risk for poor health outcomes during emergencies.

Recent research shows that the SVI also can help clinicians and researchers examine and better understand health disparities in pediatric trauma patients and identify at-risk populations for more targeted resource allocation and intervention.

“We wanted to better understand whether an injured pediatric patient experiences differences in outcomes with surgical recovery based on their SVI?” says researcher Annie Kulungowski, MD, an associate professor of pediatric surgery in the University of Colorado Department of Surgery. “Unfortunately, we found that patients with higher social vulnerability are more likely to develop surgical site infections, which can prolong their recovery.”

Social vulnerability and trauma surgery

The research originated with a conversation Kulungowski had with Catherine Velopulous, MD, a professor of GI, trauma, and endocrine surgery in the CU Department of Surgery, about research Velopulous had previously conducted with Heather Carmichael, MD. That research studied the association between social vulnerability and access to gallbladder surgery (cholecystectomy).

“We originally discussed taking a similar approach with patients who had appendicitis, but opted to study trauma surgery because it’s a bit more impactful for our patient population,” Kulungowski explains. “Traumatic injury is how the majority of our children in this country die, unfortunately. I had observed that some of our trauma victims come from different socioeconomic geographic areas and wanted to understand whether those patients are more likely to be exposed to traumatic injury.”

Kulungowski collaborated with research fellow Jenny Stevens, MD, MPH, as well Velopulous and other researchers from the CU Department of Surgery to study Children’s Hospital Colorado surgical pediatric trauma patient data.

Trauma surgery generally aligns into one of two broad categories: blunt or penetrating. Blunt trauma results from incidents such as motor vehicle crashes, auto versus pedestrian injuries, ski and snowboard crashes, and others. Penetrating trauma generally results from gunshots or stabbings.

The researchers used a trauma data registry and stratified patients into high and low SVI groups, or those with higher or lower social vulnerability.

Impacting surgical outcomes

Of the 355 pediatric surgical patients included in the data analysis, 21.4% had high SVI percentiles while 78.6% had low SVI percentiles. Those with high SVI percentiles were more likely to belong to a minority group, have government-issued insurance, present with penetrating injuries, and develop surgical site infections compared to the low SVI group.

“I think this was something many of us suspected, but now we have data that demonstrate these disparities in outcomes exist,” Kulungowski says. “Anecdotally and based on observation, we have more penetrating injury related to gunshots than stabbings in our patient population, and sadly we’re seeing this with increased frequency.”

The research findings demonstrate how the SVI may be used to further examine health care disparities and potentially inform resource allocation and intervention, Kulungowski says. They also highlight how surgeons can be a part of larger, community-wide conversations about addressing disparities and social vulnerabilities, which include gun violence and the need for gun safety.

“Gun violence can be a very intense subject, but one of the ways we as individual practitioners can address it on just a day-to-day level is when we’re getting a patient history,” Kulungowski says. “Part of that is social history – do you smoke, do you drink – and for children and parents I now ask, ‘Do you have guns in the home?’ And if they say yes, I ask if they’re in a locked location.

“This can be an uncomfortable conversation to have in the clinic, but this is my way to educate the public. This research reminds us that there are certain pediatric populations at increased risk for exposure to violence and penetrating trauma with downstream consequences for worse post-surgical outcomes. As medical providers, we need to be asking how we can come together to create education that impacts these children at risk to prevent violent injury.”

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Annie Kulungowski, MD