K. E. Leibl1, E. K. Awad3, C. Kerby2, T. A. Swain2, R. L. Griffin2, T. W. King2 1University Of Wisconsin,Madison, WI, USA 2University Of Alabama at Birmingham,Birmingham, Alabama, USA 3University Of South Alabama,Mobile, AL, USA
Introduction: Previous studies have shown that disparities in treatment and access to care by race, age, and insurance coverage exist in the US. Our goal was to determine if disparities in treatment, specifically surgical versus nonsurgical treatment and time delay from admission to treatment, exist by race, sex, age, and insurance coverage for patients treated for facial fractures at a level 1 trauma center in the southern US.
Methods: Patients with facial fractures who were admitted for treatment at a level 1 trauma center from 2010-2014 were identified using the trauma registry. ICD-9 diagnosis codes 802-802.9 were used to identify patients with facial fractures. ICD-9 procedural codes were used to determine which patients underwent surgical repair procedures. Patient demographic information, injury characteristics, and clinical data were compared by surgical repair status using a chi-square and t-test for categorical and continuous variables, respectively. Analysis of variance was used for comparison of time to surgery for demographic variables.
Results: There were 2267 patients with facial fractures from 2010-2014, 473 of which underwent reparative operatory procedures. There was a significant difference in age between those undergoing reparative surgery (40.5±17.4) compared to those who did not undergo surgical procedures (42.8±18.8) (p=0.0088). Those undergoing operative procedures had significantly longer length of stay (13.0±12.8 versus 8.1±13.5, p<0.0001), number of days in the intensive care unit (6.8±9.0 versus 4.3±9.5, p<0.0001), and higher facial abbreviated injury score (2.0±0.6 versus 1.8±0.5, p<0.0001) compared to those who did not. There were no observed differences in surgical status of facial fractures by sex (p=0.6264), race (p=0.8602), payment type (p=0.5044), or injury severity score (p=0.0528). When comparing the time from injury to admission, those undergoing surgical procedures waited longer to seek care when compared to those who did not undergo surgery (0.42 days versus 0.21 days, p=0.0069). Time to facial surgical procedure from admission was slightly longer for females (4.6±6.3 days) compared to males (3.7±4.0 days) (p=0.0643) and for whites (4.2±5.0 days) compared to blacks (3.07±3.8 days) and others (3.3±3.16 days) (p=0.0556).
Conclusion: Patients receiving nonsurgical care were slightly older than those receiving surgical repair. Female patients undergoing surgical treatment had a slightly longer wait time than males. This data does not support previous studies’ findings of disparities in treatment based on race and insurance status. This may be attributable to the diversity of this trauma center’s patient population and staff and possibly a higher level of cultural competency in treatment. Further investigations utilizing a multicenter, nationwide database should be performed to verify and validate these results.