Citation

Ahmed A, Harland KK, Hoffman B, Liao J, Choi K, Skeete DA, Denning G. West. J. Emerg. Med. 2015; 16(5): 632-641.

Affiliation

University of Iowa, Department of Emergency Medicine, Iowa City, Iowa.

Copyright

(Copyright © 2015, California Chapter of the American Academy of Emergency Medicine)

DOI

10.5811/westjem.2015.7.27351

PMID

26587084

PMCID

PMC4644028

Abstract

INTRODUCTION: National studies of largely urban populations showed increased risk of traumatic death among uninsured patients, as compared to those insured. No similar studies have been done for major trauma centers serving rural states.

METHODS: We performed retrospective analyses using trauma registry records from adult, non-burn patients admitted to a single American College of Surgeons-certified Level 1 trauma center in a rural state (2003-2010, n=13,680) and National Trauma Data Bank (NTDB) registry records (2002-2008, n=380,182). Risk of traumatic death was estimated using multivariable logistic regression analysis.

RESULTS: We found that 9% of trauma center patients and 27% of NTDB patients were uninsured. Overall mortality was similar for both (~4.5%). After controlling for covariates, uninsured trauma center patients were almost five times more likely to die and uninsured NTDB patients were 75% more likely to die than commercially insured patients. The risk of death among Medicaid patients was not significantly different from the commercially insured for either dataset.

CONCLUSION: Our results suggest that even with an inclusive statewide trauma system and an emergency department that does not triage by payer status, uninsured patients presenting to the trauma center were at increased risk of traumatic death relative to patients with commercial insurance.

Language: en