Insurance disparities have been suggested to influence the medical and surgical outcomes of adult patients with spinal cord injury (SCI), with a paucity of studies demonstrating their impact on the outcomes of pediatric and adolescent SCI patients. The aim of this study was to assess the impact of insurance status on healthcare utilization and outcomes in adolescent patients presenting with SCI.
An administrative database study was performed using the 2017 admission year from 753 facilities using the National Trauma Data Bank. Adolescent patients (11–17 years old) with cervical/thoracic SCIs were identified usingInternational Classification of Diseases, Tenth Revision, Clinical Modificationcoding. Patients were categorized by governmental insurance versus private insurance/self-pay. Patient demographics, comorbidities, imaging, procedures, hospital adverse events (AEs), and length of stay (LOS) data were collected. Multivariate regression analyses were used to determine the effect of insurance status on LOS, any imaging or procedure, or any AE.
Of the 488 patients identified, 220 (45.1%) held governmental insurance while 268 (54.9%) were privately insured. Age was similar between the cohorts (p = 0.616), with the governmental insurance cohort (GI cohort) having a significantly lower proportion of non-Hispanic White patients than the private insurance cohort (PI cohort) (GI: 43.2% vs PI: 72.4%, p < 0.001). While transportation accident was the most common mechanism of injury for both cohorts, assault was significantly greater in the GI cohort (GI: 21.8% vs PI: 3.0%, p < 0.001). A significantly greater proportion of patients in the PI cohort received any imaging (GI: 65.9% vs PI: 75.0%, p = 0.028), while there were no significant differences in procedures performed (p = 0.069) or hospital AEs (p = 0.386) between the cohorts. The median (IQR) LOS (p = 0.186) and discharge disposition (p = 0.302) were similar between the cohorts. On multivariate analysis, with respect to governmental insurance, private insurance was not independently associated with obtaining any imaging (OR 1.38, p = 0.139), undergoing any procedure (OR 1.09, p = 0.721), hospital AEs (OR 1.11, p = 0.709), or LOS (adjusted risk ratio −2.56, p = 0.203).
This study suggests that insurance status may not independently influence healthcare resource utilization and outcomes in adolescent patients presenting with SCIs. Further studies are needed to corroborate these findings.
INCLUDE WHEN CITINGPublished online March 31, 2023; DOI: 10.3171/2023.2.PEDS22506.
DisclosuresDr. Tuason reported personal fees from DePuy Synthes and OrthoPediatrics outside the submitted work.
National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance.University of Alabama at Birmingham;2016.
JonesTM,AndersonPA,NoonanKJ.Pediatric cervical spine trauma.J Am Acad Orthop Surg.2011;19(10):600–611.
BlissD,SilenM.Pediatric thoracic trauma.Crit Care Med.2002;30(11 suppl):S409–S415.
GopinathanNR,ViswanathanVK,CrawfordAH.Cervical spine evaluation in pediatric trauma: a review and an update of current concepts.Indian J Orthop.2018;52(5):489–500.
PoormanGW,SegretoFA,BeaubrunBM,et al.小儿颈椎创伤性骨折: etiology, epidemiology, concurrent injuries, and an analysis of perioperative outcomes using the Kids’ Inpatient Database.Int J Spine Surg.2019;13(1):68–78.
SakowskiJA,KahnJG,KronickRG,NewmanJM,LuftHS.Peering into the black box: billing and insurance activities in a medical group.Health Aff (Millwood).2009;28(4):w544–w554.
SelvarajahS,SchneiderEB,BeckerD,SadowskyCL,HaiderAH,HammondER.The epidemiology of childhood and adolescent traumatic spinal cord injury in the United States: 2007-2010.J Neurotrauma.2014;31(18):1548–1560.
StrotherMC,MichelKF,XiaL,et al.Prolonged length of stay after robotic prostatectomy: causes and risk factors.Ann Surg Oncol.2020;27(5):1560–1567.
BateniSB,MeyersFJ,BoldRJ,CanterRJ.Increased rates of prolonged length of stay, readmissions, and discharge to care facilities among postoperative patients with disseminated malignancy: implications for clinical practice.PLoS One.2016;11(10):e0165315.
CollinsTC,DaleyJ,HendersonWH,KhuriSF.Risk factors for prolonged length of stay after major elective surgery.Ann Surg.1999;230(2):251–259.
WallnerLP,DunnRL,SarmaAV,CampbellDAJr,WeiJT.Risk factors for prolonged length of stay after urologic surgery: the National Surgical Quality Improvement Program.J Am Coll Surg.2008;207(6):904–913.
KumarN,PatelRS,WangSSY,et al.Factors influencing extended hospital stay in patients undergoing metastatic spine tumour surgery and its impact on survival.J Clin Neurosci.2018;56:114–120.
BasquesBA,BohlDD,GolinvauxNS,GruskayJA,GrauerJN.Preoperative factors affecting length of stay after elective anterior cervical discectomy and fusion with and without corpectomy: a multivariate analysis of an academic center cohort.Spine (Phila Pa 1976).2014;39(12):939–946.
PiattJ,ImperatoN.Epidemiology of spinal injury in childhood and adolescence in the United States: 1997-2012.J Neurosurg Pediatr.2018;21(5):441–448.
VitaleMG,GossJM,MatsumotoH,RoyeDPJr.Epidemiology of pediatric spinal cord injury in the United States: years 1997 and 2000.J Pediatr Orthop.2006;26(6):745–749.
SiresJ,OvendenC,AntoniouG,RobinsonN,WilliamsN.An audit of computed tomography request practices for suspected cervical spine injury post-guideline change in a tertiary referral paediatric hospital.ANZ J Surg.2022;92(1-2):180–187.
WaddellVA,ConnellyS.Decreasing radiation exposure in pediatric trauma related to cervical spine clearance: a quality improvement project.J Trauma Nurs.2018;25(1):38–44.
BookerJ,HallS,DandoA,et al.Paediatric spinal trauma presenting to a UK major trauma centre.Childs Nerv Syst.2021;37(6):1949–1956.
ElerakyMA,TheodoreN,AdamsM,RekateHL,SonntagVK.Pediatric cervical spine injuries: report of 102 cases and review of the literature.J Neurosurg.2000;92(1 suppl):12–17.
KulshresthaR,KuiperJH,MasriWE,et al.Scoliosis in paediatric onset spinal cord injuries.Spinal Cord.2020;58(6):711–715.
DearolfWWIII,BetzRR,VogelLC,LevinJ,ClancyM,SteelHH.Scoliosis in pediatric spinal cord-injured patients.J Pediatr Orthop.1990;10(2):214–218.
VogelLC,KrajciKA,AndersonCJ.Adults with pediatric-onset spinal cord injury: part 1: prevalence of medical complications.J Spinal Cord Med.2002;25(2):106–116.
McCarthyJJ,ChafetzRS,BetzRR,GaughanJ.Incidence and degree of hip subluxation/dislocation in children with spinal cord injury.J Spinal Cord Med.2004;27(suppl 1):S80–S83.
WangJZ,YangM,MengM,LiZH.的临床特点和治疗脊髓cord injury in children and adolescents.Chin J Traumatol.2023;26(1):8–13.
VogelLC,AndersonCJ.Spinal cord injuries in children and adolescents: a review.J Spinal Cord Med.2003;26(3):193–203.
SchottlerJ,VogelLC,SturmP.Spinal cord injuries in young children: a review of children injured at 5 years of age and younger.Dev Med Child Neurol.2012;54(12):1138–1143.
FlanaganA,KellyEH,VogelLC.Psychosocial outcomes of children and adolescents with early-onset spinal cord injury and those with spina bifida.Pediatr Phys Ther.2013;25(4):452–459.
HiremathSV,KarmarkarAM,KumarA,CoffmanDL,MarinoRJ.Factors associated with post-acute functional status and discharge dispositions in individuals with spinal cord injury.J Spinal Cord Med.2022;45(1):126–136.
SedneyCL,KhanU,DekeseredyP.Traumatic spinal cord injury in West Virginia: disparities by insurance and discharge disposition from an acute care hospital.J Spinal Cord Med.2020;43(1):106–110.
LindemuthM,GarweT,VenincasaK,et al.The paralyzing effect of insurance status on throughput of acute spinal cord patients.Am J Surg.2019;217(6):1060–1064.
YarbroughCK,GamblePG,Burhan JanjuaM,et al.Readmission after spinal cord injury: analysis of an institutional cohort of 795 patients.J Neurosurg Sci.2018;62(3):265–270.
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