Insurance status is a potent predictor of outcomes in both blunt and penetrating trauma

Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
American journal of surgery (Impact Factor: 2.29). 04/2010; 199(4):554-7. DOI: 10.1016/j.amjsurg.2009.11.005
Source: PubMed


Patients with penetrating injuries are known to have worse outcomes than those with blunt trauma. We hypothesize that within each injury mechanism there should be no outcome difference between insured and uninsured patients.
The National Trauma Data Bank version 7 was analyzed. Patients aged 65 years and older and burn patients were excluded. The insurance status was categorized as insured (private, government/military, or Medicaid) and uninsured. Multivariate analysis adjusted for insurance status, mechanism of injury, age, race, sex, injury severity score, shock, head injury, extremity injury, teaching hospital status, and year.
A total of 1,203,243 patients were analyzed, with a mortality rate of 3.7%. The death rate was significantly higher in penetrating trauma patients versus blunt trauma patients (7.9% vs 3.0%; P < .001), and higher in the uninsured (5.3% vs 3.2%; P < .001). On multivariate analysis, uninsured patients had an increased odds of death than insured patients, in both penetrating and blunt trauma patients. Penetrating trauma patients with insurance still had a greater risk of death than blunt trauma patients without insurance.
Insurance status is a potent predictor of outcome in both penetrating and blunt trauma.

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Available from: Tolulope A Oyetunji
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    • "Being uninsured has been linked to decreased access to post-trauma care, as well as increased risk of penetrating trauma injury[17,18]. Lack of insurance is also associated with increased morbidity and greater cost of care when compared with insured patients with similar injury mechanism19202122. As federal and state support of safety net hospitals and patients has decreased, the financial burden of poorly insured patients has received more scrutiny. "
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    • "Multiple patient demographic and injury severity variables were controlled for in the analysis, in accordance with previously recommended best practices for analyses using NTDB data [10]. The following variables were included in the generalized linear models, with mortality as the outcome: patient age, patient sex [11], anatomic severity (Injury Severity Score [ISS]), physiologic severity (hypotension at presentation) [12], type of injury [13], Glasgow Coma Scale, ventilator use, injury intentionality, and insurance status [14]. The RR of death among white trauma patients was multiplied by the number of black trauma deaths reported in the Fig. 1 e Study inclusion. "
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