Annie Falor1, Dennis Kim1, Scott Bricker1, Angela Neville1, Frederic Bongard1, Brant Putnam1, David Plurad2. 1. Division of Trauma-Acute Care Surgery and Surgical Critical Care, Department of Surgery, Harbor-UCLA, Medical Center, Torrance, California. 2. Division of Trauma-Acute Care Surgery and Surgical Critical Care, Department of Surgery, Harbor-UCLA, Medical Center, Torrance, California. Electronic address: dsplurad@yahoo.com.
Abstract
BACKGROUND: The purpose of this study was to investigate the relationship between insurance status and outcomes for trauma patients presenting without vital signs undergoing urgent intervention. MATERIALS AND METHODS: The National Trauma Data Bank was queried for patients presenting with a systolic blood pressure equal to zero and a Glasgow Coma Scale score of three ("clinically dead"), who underwent urgent thoracotomy and-or laparotomy (UTL). Insured patients were compared with uninsured (INS [-]) patients. RESULTS: There were 18,171 patients presenting clinically dead having a payment source documented. INS (-) patients were more likely to undergo UTL (5.4% [416-7704] versus 2.7% [285-10,467], 1.481 [1.390-1.577], <0.001). Out of 689 patients who underwent UTL and meeting inclusion criteria, 416 (60.4%) were INS (-). Patients with insurance demonstrated a significantly greater survival (9.9% [27-273] versus 1.7% [7-416], 5.878 [2.596-13.307] P < 0.001). Adjusting for mechanism, race, age, injury severity, and comorbidities, insured status was independently associated with survival. CONCLUSIONS: The presence of health insurance is independently associated with survival in trauma patients presenting with cardiovascular collapse who undergo urgent surgical intervention.
BACKGROUND: The purpose of this study was to investigate the relationship between insurance status and outcomes for traumapatients presenting without vital signs undergoing urgent intervention. MATERIALS AND METHODS: The National Trauma Data Bank was queried for patients presenting with a systolic blood pressure equal to zero and a Glasgow Coma Scale score of three ("clinically dead"), who underwent urgent thoracotomy and-or laparotomy (UTL). Insured patients were compared with uninsured (INS [-]) patients. RESULTS: There were 18,171 patients presenting clinically dead having a payment source documented. INS (-) patients were more likely to undergo UTL (5.4% [416-7704] versus 2.7% [285-10,467], 1.481 [1.390-1.577], <0.001). Out of 689 patients who underwent UTL and meeting inclusion criteria, 416 (60.4%) were INS (-). Patients with insurance demonstrated a significantly greater survival (9.9% [27-273] versus 1.7% [7-416], 5.878 [2.596-13.307] P < 0.001). Adjusting for mechanism, race, age, injury severity, and comorbidities, insured status was independently associated with survival. CONCLUSIONS: The presence of health insurance is independently associated with survival in traumapatients presenting with cardiovascular collapse who undergo urgent surgical intervention.
Authors: Anu Ramachandran; Anju Ranjit; Cheryl K Zogg; Juan P Herrera-Escobar; Jessica R Appelson; Luis F Pino; Michel B Aboutanous; Adil H Haider; Carlos A Ordonez Journal: World J Surg Date: 2017-09 Impact factor: 3.352