Social and Economic Factors and Disparities in Pediatric Trauma Care: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
BACKGROUND: Social and economic factors are known to influence childhood injury risks and outcomes. However, the relationship between these factors and the delivery of pediatric trauma care remains unclear. OBJECTIVE: To examine the association between social and economic factors, defined using the Place of residence, race and ethnicity/culture/language, occupation, gender and sex, religion, education, socioeconomic status, social capital-Plus framework, and health care delivery among injured children and adolescents. DATA SOURCES: We searched PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, and Academic Search Premier from inception to July 27, 2024. STUDY ELIGIBILITY CRITERIA: Studies evaluating associations between one or more social and economic factors and health care delivery in injured children aged ≤19 years, regardless of injury type or health care setting. APPRAISAL AND SYNTHESIS METHODS: Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the Risk of Bias in Non-randomized Studies - of Exposure tool. We performed meta-analyses using random-effects models. RESULTS: Among 73 eligible studies, 28 contributed to meta-analyses. No disparities were observed in imaging or in transfer to a pediatric center. Non-Hispanic Black (OR = 1.68, 95% CI: 1.51-1.87) and Hispanic (OR = 1.35, 95% CI: 1.22-1.50) children were more likely to receive any analgesic in the emergency department, but less likely to receive opioids during emergency department visits or at discharge. Girls had lower odds of opioid prescription (OR = 0.95, 95% CI: 0.92-0.97). Self-pay and public insurance were associated with reduced opioid access and differences in hospital admission, surgery, and access to rehabilitation services. LIMITATIONS: Predominance of U.S.-based studies and high risk of methodological bias. CONCLUSIONS: There are disparities in pediatric trauma care delivery. Standardized protocols may protect against disparities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.025 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.011 | 0.029 |
| Bibliometrics | 0.005 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".