As a pediatric trauma surgeon in the University of Colorado Anschutz Department of Surgery, Shannon Acker, MD, knows the statistic all too well: Traumatic injuries are the leading cause of death in children aged 1-14.
In an effort to better understand how and where traumatic injuries occur in children, Acker recently led a research study looking at how the Area Deprivation Index (ADI) — a tool that measures social disadvantages in specific neighborhoods — can predict levels and outcomes of traumatic pediatric injuries. Results were published in March in the Journal of Pediatric Surgery.
“The ADI was initially developed as a means for the federal government to identify neighborhoods that are at higher risk after a natural disaster, so they can prioritize where to send resources,” Acker says. “It’s a composite score that takes multiple factors into consideration, including income, employment, and education levels; housing quality; home ownership rates; and the percentage of residents who speak English as a primary language.”
Higher ADI equals more traumatic injuries
By analyzing five years’ worth of data from the Children’s Hospital Colorado pediatric trauma center, Acker and her co-researchers found that patients who lived in neighborhoods with higher ADI scores were more likely to be injured via auto-pedestrian injuries, motor vehicle crashes, and assault, neglect or child abuse. Burn injuries were also higher in areas with higher deprivation scores.
“We looked at the severity of injury, and we found that children who live in neighborhoods with higher deprivation were more severely injured,” she says. “We also found that, when you look at patient outcomes, even though the children from neighborhoods with higher ADI scores were more severely injured, the outcomes were all the same. Once the children came to our hospital, their outcomes were equivalent, which is good news. It says that once you make it to the hospital, you're getting the same care, even though the things that happen to you that get you to our hospital are different based on where you live.”
Using the data for good
Acker and her research team are now acting on the data, looking to identify areas in high-ADI neighborhoods that also have high rates of auto-pedestrian injuries.
“Then we're able to go to those areas and conduct environmental surveys,” she says. “We look at what the speed limit is. Are there medians? Are there crosswalks? Is there a school nearby? Is there a bus stop?”
Working with an advocacy group at Children’s Colorado, the researchers plan to request traffic control measures in high-incident areas where none exist. She foresees similar efforts in rural areas to see if other types of disparities exist. It’s a way, she says, of addressing traumatic injury prevention in the entire seven-state region served by the Children’s Colorado Regional Pediatric Trauma Center.
“This methodology is powerful, and we can use it to target interventions that are specific to the location,” she says. “If in rural areas, there are a lot of children being injured in car crashes, then you can advocate for stoplights and lower speed limits. In urban areas, where there are more auto-pedestrian injuries, you can advocate for medians and crosswalks.”
Other applications
Acker hopes other researchers use her data to conduct similar efforts to reduce traumatic injuries in high-ADI neighborhoods.
“This paper is proof that this index is valuable,” she says. “We used to focus on factors intrinsic to an individual that they can't change, like race or ethnicity. But these neighborhood factors are outside of the individual level. These are things society could intervene upon.”
