Impact of Social Determinants of Health on Pediatric Facial Trauma

Introduction: Pediatric facial trauma differs from its adult counterpart both in presentation and injury patterns. More information is needed about pediatric facial trauma to better improve prevention efforts and patient education. The goal of the present study is to identify the impact of race, ethnicity and sociodemographic factors on type and mechanism of pediatric facial trauma.

Methods: Retrospective observational cohort study of patients < 18 years of age seen for facial trauma at a metropolitan, tertiary pediatric hospital from 2016 to 2022.

Results: 10,714 patients presented with facial trauma (median age 4.97, 62% male). Lacerations represented 79.6% (n=8,523) of facial traumas, followed by bony trauma at 14.3% (n=1,531). Median age for lacerations was 4.72 years, as compared to 10.6 years for the bony trauma group. Mechanism of injury was available for 5,635 patients, with 70.6% due to motor vehicle collision (MVC) (n=3,981), 17.9% due to dog bite (n= 1,007), and 4.76% from gunshot wounds (GSW) (n=268). MVCs were positively associated with female sex (OR 1.15, p< 0.001), Black race (OR 1.36, p< 0.001), public insurance (OR 1.12, p< 0.001) and older age (median age 10.95, p< 0.001). Dog bites were positively associated with White race (OR 3.32, p< 0.001), Hispanic/Latino ethnicity (OR 1.25, p< 0.001), private insurance (OR 1.97, p< 0.001) and younger age (median age 7.26, p< 0.001). GSWs were positively associated with male sex (OR 3.15, p< 0.001), Black race (OR 2.19, p< 0.001), and older age (median age 15.85, p< 0.001).

Conclusions: Facial lacerations and bony trauma were the two most common types of pediatric facial trauma. The most common mechanism of injury was motor vehicle collision, followed by dog bites and gunshot wounds. Age, race, ethnicity and insurance played significant, but varying roles in mechanisms of injury to the face.