H. C. Budnick1, A. Tyroch1, S. Milan1 1Texas Tech University Health Sciences Center In El Paso Paul L. Foster School Of Medicine,Department Of Surgery,El Paso, TX, USA
Introduction:
Traumatic brain injury (TBI) is a leading cause of death in the United States and the largest and most swiftly growing population of these injuries in the United States is among the Hispanic population. Functional outcomes for TBI cases can be significantly improved by post-hospitalization rehabilitation including intensive physical, occupational, and cognitive rehabilitation. This treatment is usually accomplished by discharge to post-hospitalization care following the acute period. In studying the referral to these facilities, Hispanics have been shown to have the lowest physician referral rate nationally. However, this relationship has not been studied in a population where Hispanics are by far the majority. This study seeks to determine if differences exist between ethnic groups in referral of TBI patients to post-hospitalization care in the Hispanic-majority population of El Paso, Texas.
Methods:
This study included 1,124 patients over the age of 18 who presented to University Medical Center in El Paso, Texas between the years of 2005-2015 with acute TBI. The patients’ age, sex, race, residence, admission GCS, GCS-Motor, Injury Severity Score (ISS), ICU and hospital length of stay (LOS), mechanism of injury, and discharge referral were extracted. The data was analyzed in univariate and multivariate analysis using SPSS.
Results:
The discharge disposition was found to be significantly different between the Hispanic and the non-Hispanic populations. 70.2% of Hispanic patients were sent home without post-hospitalization care whereas only 53.5% of the non-Hispanic patients were sent home. Hispanics were also sent to acute care facilities 6.9% of the time and to rehabilitation centers 18.5% of the time compared to non-Hispanics who were sent to acute care facilities 10.8% of the time and to rehabilitation 27.5% of the time. Further, the ages of presentation, mechanism of injury, LOS, ISS, GCS, and GCS-M were comparable between the ethnic groups.
Conclusion:
The Hispanic population has been shown to be discharged to post-hospitalization care facilities at a lower rate as compared to non-Hispanic populations. This remains true even where the overwhelming majority of the population is Hispanic such as El Paso, Texas. Further, when risk factors for poor outcomes were stratified by ethnicity, there was no appreciable difference. This suggests that TBI patients of comparable traumatic severity and functional outcome probability but different ethnicities are discharged without further care at different rates.