Child Opportunity Index Predicts Outcomes in Pediatric Spine Trauma: A Novel Application of Social Determinants of Health.

Abstract

Objectives: Social factors play a crucial role in health outcomes for pediatric patients, yet in the neurosurgery pediatric literature, these factors are rarely reported. To develop a deeper understanding of pediatric spine trauma outcomes, we investigate demographic and social factors measured by the Child Opportunity Index (COI) and Social Deprivation Index (SDI). We hypothesize that social factors predict clinical presentation, injury severity, and clinical outcomes. Methods: We conducted a retrospective cohort study of pediatric patients treated for spinal trauma at a Level 1 trauma center in Sacramento, California. We collected patient clinical data such as mechanisms of injury (MOIs), length of stay (LOS), treatment type, hospital disposition, polytrauma incidence, and follow-up attendance. Each patient's social environment was characterized using COI and SDI metrics. Statistical comparisons were performed to assess associations between social factors and clinical outcomes. Results: Patients with worse childhood opportunity (lower COI and higher SDI) were more likely to be insured through Medi-Cal, identify as Hispanic, and experience violent MOI. Female patients were more likely to sustain polytrauma and had a higher likelihood of requiring surgical intervention. Additionally, patients from underserved communities demonstrated longer hospital stays and poorer follow-up adherence, with COI and SDI scores correlating with these disparities. Conclusion: Social disparities are associated with worse outcomes in pediatric spine trauma. We found COI and SDI to be valuable clinical metrics, motivating further research to be carried out at the state and national levels. These findings highlight health disparities in pediatric spine trauma.