D. A. Alber1, T. Uribe-Leitz1, G. Ortega1, A. Salim2, A. Haider1, M. P. Jarman1 1Brigham And Women’s Hospital,Center Of Surgery And Public Health,Boston, MA, USA 2Brigham And Women’s Hospital,Trauma, Burns, And Surgical Critical Care,Boston, MA, USA
Introduction: Racial disparities in trauma care are well-established. Disparities in the treatment of severely injured patients at hospitals without designated trauma services, defined as under-triage, have been observed for certain interest groups (e.g. children, and older adults). The relationship between race/ethnicity and under-triage remains unknown. We sought to examine if differences by race and ethnicity exist in trauma center care following severe traumatic injury.
Methods: We performed a retrospective cohort analysis of patients with severe traumatic injury in 21 geographically diverse states from the 2014 HCUP State Inpatient Databases, linked with hospitals’ trauma center status from the American Hospital Association Annual Survey. Under-triage was defined as treatment at a Level III/IV or non-trauma center for patients with an injury severity score > 15. Multivariable logistic regression models were used to compare the likelihood of undertriage between White, African American, and Hispanic patients, adjusting for sex, age, injury severity, injury mechanism, and patient urban/rural residence. Our primary analysis included all severely injured patients. Sub-analyses of patients with penetrating injury and rural residents were also conducted.
Results: A total of 83,817 severely injured patients were identified, 55.4% of patients were under-triaged. Unadjusted rates of under-triage were highest among White patients (58.5%), followed by Hispanic patients (56.8%), and African American patients (43.4%). Compared to White patients, adjusted odds of under-triage were higher for Hispanic patients (Odds Ratio [OR]=1.16, 95% Confidence Interval [CI]=1.11, 1.22), and lower for African American patients (OR=0.68, 95% CI=0.65, 0.72) and patients of other races (OR=0.70, 95% CI=0.67,0.72). Sub-analysis of patients with penetrating injuries showed a similar pattern for African American and Other Race. Under-triage rates did not vary by race or ethnicity in sub-analysis of rural patients.
Conclusion: Urban Hispanic patients possess significantly higher rates of under-triage compared to their White counterparts, while African American patients experience significantly lower rates of under-triage. Under-triage rates for rural populations do not vary by race or ethnicity. Increased under-triage rates for Hispanic patients may be the result of the geographic distribution of Hispanic populations relative to trauma centers, or language barriers inhibiting prehospital providers’ ability to effectively assess patient status. Future studies should attempt to include larger populations of Hispanic patients, consider additional geographic measures, as well as cultural and language barriers to care for Hispanic populations.
