extremity vascular injuries: Increased mortality for minorities and the uninsured?

Vascular Trauma


Lower extremity vascular injuries: Increased mortality for minorities and the uninsured?


Crandall M, Sharp D, Brasel K, et al (Dept of Surgery at Northwestern Univ Feinberg School of Medicine, Chicago, IL; Dept of Surgery at the Med College of Wisconsin, Milwaukee; et al) Surgery 150:656–664, 2011§



G.L. Moneta, MD



Evidence Ranking


• C



Expert Rating


• 1



Abstract



Background


There is increasing evidence to suggest that racial disparities exist in outcomes for trauma. Minorities and the uninsured have been found to have higher mortality rates for blunt and penetrating trauma. However, mechanisms for these disparities are incompletely understood. Limiting the inquiry to a homogenous group, those with lower extremity vascular injuries (LEVIs), may clarify these disparities.



Methods


The National Trauma Data Bank (NTDB; version 7.0, American College of Surgeons) was used for this study. LEVIs were identified using codes from the International Classification of Diseases, 9th revision. Univariate and multivariate analyses were performed using Stata software (version 11; StataCorp, LP, College Station, TX).



Results


Records were reviewed for 4,928 LEVI patients. The mechanism of injury was blunt in 2,452 (49.8%), penetrating in 2,452 (49.8%), and unknown in 24 cases (0.5%). Mortality was similar by mechanism (7.6% overall). Regression analysis using mechanism as a covariate revealed a significantly worse mortality for people of color (POC; odds ratio [OR], 1.45; 95% confidence interval [CI], 1.03–2.02; P = .03) and the uninsured (UN; OR, 1.62; 95% CI, 1.15–2.23; P = .006). However, when separate analyses were performed stratifying by mechanism, no significant mortality disparities were found for blunt trauma (POC OR, 1.28; 95% CI, 0.85–1.96; P = .23; UN OR, 1.33; 95% CI, 0.78–2.22; P = .29), but disparities remained for penetrating trauma (POC OR, 1.81; 95% CI, 0.93–3.57; P = .08; UN OR, 1.85; 95% CI, 1.18–2.94; P = .009).

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Apr 1, 2017 | Posted by in CARDIOLOGY | Comments Off on extremity vascular injuries: Increased mortality for minorities and the uninsured?

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