Citation

Tignanelli CJ, Watarai B, Fan Y, Petersen A, Hemmila M, Napolitano L, Jarosek S, Charles A. Am. Surg. 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, Southeastern Surgical Congress)

DOI

10.1177/0003134820947369

PMID

32931304

Abstract

INTRODUCTION: Racial and socioeconomic disparities in health access and outcomes for many conditions is well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American ([AA] vs White) males with high-grade splenic injuries.

METHODS: Data from the National Trauma Data Bank were utilized from 2007 to 2015; 24 855 AA or White males with high-grade splenic injuries were included. Multilevel mixed-effects regression analysis was used to evaluate disparities in outcomes and resource allocation.

RESULTS: Mortality was significantly higher for AA males at mixed-race (OR 1.6; 95% CI 1.3-2.1; P <.001) and minority (OR 2.1; 95% CI 1.5-3.0; P <.001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI, 0.49-0.97; P =.04) and experienced a significantly longer time to surgery (IRR 1.5; P =.02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2, P =.009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P =.046 vs minority hospitals: OR 1.6; P =.08).

DISCUSSION: While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.

Language: en

Keywords

racial disparities; splenic trauma; trauma systems