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

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusions

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

      Keywords

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      References

      1. Center for Disease Control and Prevention's National Center for Health Statistics: National Vital Statistics System. GA, Atlanta2004
        • Morris Jr, J.A.
        • Mackenzie E.J.
        • Edelstein S.L.
        The effect of preexisting conditions on mortality in trauma patients.
        JAMA. 1990; 263: 1942-1946
        • Haider A.H.
        • Chang D.C.
        • Efron D.T.
        • et al.
        Race and insurance status as risk factors for trauma mortality.
        Arch Surg. 2008; 143: 945-949
        • Brohi K.
        Peripheral vascular trauma.
        (Accessed May 15, 2009)
        • Haas J.S.
        • Goldman L.
        Acutely injured patients with trauma in Massachusetts: differences in care and mortality, by insurance status.
        Am J Public Health. 1994; 84: 1605-1608
        • Ayania J.Z.
        • Weissman J.S.
        • Schneider E.C.
        • et al.
        Unmet health needs of uninsured adults in the United States.
        JAMA. 2000; 284: 2061-2069
        • Richardson L.C.
        • Tian L.
        • Voti L.
        • et al.
        The roles of teaching hospitals, insurance status, and race/ethnicity in receipt of adjuvant therapy for regional-stage breast cancer in Florida.
        Am J Public Health. 2006; 96: 160-166
        • Milzman D.P.
        • Boulanger B.R.
        • Rodriquez A.
        • et al.
        Pre-existing disease in trauma patients: a predictor or fate independent of age and injury severity score.
        J Trauma. 1992; 32: 236-244
        • Marcin J.P.
        • Schembri M.S.
        • Jinsong H.
        • et al.
        A population-based analysis of socioeconomic status and insurance status and their relationship with pediatric trauma hospitalization and mortality rates.
        Am J Public Health. 2003; 93: 461-466
        • Williams M.V.
        • Davis T.
        • Parker R.M.
        • et al.
        The role of health literacy in patient-physician communication.
        Fam Med. 2002; 34: 383-389
        • Cornwell 3rd, E.E.
        • Velmahos G.C.
        • Berne T.V.
        • et al.
        Lethal abdominal gunshot wounds at a level I trauma center: analysis of TRISS (Revised Trauma Score and Injury Severity Score) fallouts.
        J Am Coll Surg. 1998; 187: 123-129
        • Ward E.
        • Ahmedin J.
        • Vilma C.
        • et al.
        Cancer disparities by race/ethnicity and socioeconomic status.
        CA Cancer J Clin. 2004; 54: 78-93
        • Johnson P.A.
        • Lee T.H.
        • Cook E.F.
        • et al.
        Effect of race on the presentation and management of patients with acute chest pain.
        Ann Intern Med. 1993; 118: 593-601