Social Determinants of Health Affect Long Term Burn Care in Pediatric Patients

Abstract

For pediatric burn patients, outpatient follow-up is essential to optimize outcomes. Social determinants of health (SDH) influence families' ability to attend clinic follow-up appointments. We hypothesize that SDH differences are associated with missing outpatient burn follow-up and therefore inferior burn-related outcomes. We performed a retrospective cohort study of patients <18 years who were admitted to our pediatric burn center during 2021-2022. Patient demographics, injury and management details, social work SDH assessment, and postinjury complications were collected. Multivariate regression was conducted to identify independent predictors of missed follow-up. Among 322 patients, median age at injury was 2.5 years (IQR: 1.4-7.8). Most patients were male (60.2%), and most were white (56.0%). Forty-six percent of patients missed one or more appointment. Patients who missed appointments less often had a primary care provider (PCP) (91.3% vs 98.1%; p=0.007) and were more commonly exposed to tobacco/illicit substances (31.8% vs 21.3%; p=0.03). Patients who attended all appointments more often had their burns managed non-surgically (81.6% vs 62.8%, p<0.0001). Controlling for relevant clinical factors, independent predictors of missing appointments included not having a PCP (aOR 6.10; 95% CI 1.25-29.81) and requiring surgical burn management (aOR 3.13; 95% CI 1.65-5.95). Next steps include collaborating with social work to improve support and resources for patients at increased risk for letting their outpatient burn care lapse, which may include establishing a PCP prior to discharge, particularly among patients requiring more extensive burn management.

Keywords: burn; contracture; missed appointments; social determinants of health.