Disparities in child protective services involvement in pediatric traumatic brain injury
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In brief
In brief
This retrospective study examines racial and ethnic disparities in child protective services involvement among pediatric traumatic brain injury patients at a level I trauma center. Despite automatic CPS referral policies for children ≤2 years, Hispanic patients showed significantly lower odds of CPS case acceptance compared to non-Hispanic White patients, revealing systemic inequities in child welfare responses to pediatric TBI.
- Automatic CPS referral policies for TBI in children ≤2 years do not eliminate racial/ethnic disparities in case acceptance.
- Hispanic patients had 62% lower odds of CPS involvement compared to non-Hispanic White patients after adjusting for injury severity.
- Abusive head trauma carries higher morbidity/mortality than accidental TBI, making accurate identification critical.
- Socioeconomic factors and insurance status differ significantly across racial/ethnic groups in pediatric TBI populations.
- Institutional protocols alone are insufficient to address systemic disparities in child welfare involvement.
Written by the GCMD Library team from the article.
Abstract
Purpose
Traumatic brain injury (TBI) is a leading cause of pediatric death and disability. Abusive head trauma confers greater morbidity and mortality compared with accidental TBI. National trends reveal disproportionate involvement of minority children in the child welfare system. The study investigates socioeconomic disparities in child protective services (CPS) involvement in pediatric TBI.
Methods
Retrospective chart review was conducted for TBI patients (n = 596) admitted to an academic pediatric level I trauma center from 2015 to 2022, where institutional policy dictates automatic CPS referral for TBI patients ≤ 2 years. Analysis of variance, chi-squared, and logistic regressions compared racial and ethnic groups and calculated adjusted odds of CPS case acceptance.
Results
Rates of non-accidental trauma, CPS involvement, insurance, and marital status differed across racial and ethnic backgrounds (p < 0.05). Of patients ≤ 2 years, Hispanic patients (OR: 0.38, 95%CI [0.16,0.91]) had decreased odds of CPS involvement compared to non-Hispanic White patients when adjusting for confounders including injury severity, injury type, and socioeconomic status.
Conclusions
We highlight racial and ethnic differences in incidence of pediatric TBI and CPS involvement, even in the setting of an automatic CPS referral policy for pediatric TBI patients ≤ 2 years.