Mark Jesin1, Stephanie Rashewsky2, Michael Shapiro3, William Tobler4, Suresh Agarwal5, Peter Burke6, Andrew Salama7. 1. Former Chief Resident, Department of Oral and Maxillofacial Surgery, Boston Medical Center and Boston University School of Dental Medicine, Boston, MA, USA. 2. Former Dental Student, Harvard School of Dental Medicine, Boston, MA, USA. 3. Resident, Department of Oral and Maxillofacial Surgery, Boston Medical Center and Boston University School of Dental Medicine, Boston, MA, USA. 4. Resident, Department of General Surgery, Boston Medical Center, Boston, MA, USA. 5. Former Chief, Surgical Critical Care at Boston Medical Center, and Associate Professor, Boston University School of Medicine, Boston, MA, USA. 6. Chief, Trauma Surgery at Boston Medical Center, and Associate Professor, Boston University School of Medicine, Boston, MA, USA. 7. Residency Director, Department of Oral and Maxillofacial Surgery, Boston Medical Center, and Assistant Professor, Boston University School of Dental Medicine, Boston, MA, USA. Electronic address: Andrew.salama@bmc.org.
Abstract
OBJECTIVE: A retrospective cross-sectional analysis was undertaken to determine the impact of race and insurance status on trauma outcomes in patients admitted to a Level I trauma center following head and neck fractures. STUDY DESIGN: Putative predictive factors, including injury mechanism, hemorrhagic shock, injury severity score (ISS), race, gender, and insurance status, were used in a multivariate outcome analysis to determine their influence on length of hospital stay, number of procedures performed, discharge status, and mortality; P < .05 was significant. RESULTS: Proportionately more male patients (76.5%) sustained head and neck fractures compared with females (23.5%). Blacks and Hispanics sustained proportionately more gunshot wounds (GSWs) compared with Whites, 16:1 and 7:1, respectively. There were no significant differences in length of hospital stay and mortality based on race or insurance status. Mortality was related to age, GSW as a mechanism of injury, increasing ISS, and shock on admission. CONCLUSIONS: Minority race and insurance status did not correlate with worse outcomes. Treatment biases in the acutely injured patient with head and neck injuries may be less prevalent than thought, if we consider mortality and utilization of care as primary outcome measures.
OBJECTIVE: A retrospective cross-sectional analysis was undertaken to determine the impact of race and insurance status on trauma outcomes in patients admitted to a Level I trauma center following head and neck fractures. STUDY DESIGN: Putative predictive factors, including injury mechanism, hemorrhagic shock, injury severity score (ISS), race, gender, and insurance status, were used in a multivariate outcome analysis to determine their influence on length of hospital stay, number of procedures performed, discharge status, and mortality; P < .05 was significant. RESULTS: Proportionately more male patients (76.5%) sustained head and neck fractures compared with females (23.5%). Blacks and Hispanics sustained proportionately more gunshot wounds (GSWs) compared with Whites, 16:1 and 7:1, respectively. There were no significant differences in length of hospital stay and mortality based on race or insurance status. Mortality was related to age, GSW as a mechanism of injury, increasing ISS, and shock on admission. CONCLUSIONS: Minority race and insurance status did not correlate with worse outcomes. Treatment biases in the acutely injured patient with head and neck injuries may be less prevalent than thought, if we consider mortality and utilization of care as primary outcome measures.
Authors: Leigh Anna Robinson; Lauren M Turco; Bryce Robinson; Joshua G Corsa; Michael Mount; Amy V Hamrick; John Berne; Dalier R Mederos; Allison G McNickle; Paul J Chestovich; Jason Weinberger; Areg Grigorian; Jeffry Nahmias; Jane K Lee; Kevin L Chow; Erik J Olson; Jose L Pascual; Rachele Solomon; Danielle A Pigneri; Husayn A Ladhani; Joanne Fraifogl; Jeffrey Claridge; Terry Curry; Todd W Costantini; Manasnun Kongwibulwut; Haytham Kaafarani; Janika San Roman; Craig Schreiber; Anna Goldenberg-Sandau; Parker Hu; Patrick Bosarge; Rindi Uhlich; Nicole Lunardi; Farooq Usmani; Joseph Victor Sakran; Jessica M Babcock; Juan Carlos Quispe; Lawrence Lottenberg; Donna Cabral; Grace Chang; Jhoanna Gulmatico; Jonathan J Parks; Rishi Rattan; Jennifer Massetti; Onaona Gurney; Brandon Bruns; Alison A Smith; Chrissy Guidry; Matthew E Kutcher; Melissa S Logan; Michelle Y Kincaid; Chance Spalding; Matthew Noorbaksh; Frances H Philp; Benjamin Cragun; Robert D Winfield Journal: Trauma Surg Acute Care Open Date: 2019-11-17