C. J. McLaughlin1, J. Hess3, S. Armen2, S. R. Allen2 1Penn State University College Of Medicine,Department Of Surgery,Hershey, PA, USA 2Penn State Hershey Medical Center,Department Of Surgery, Division Of Trauma, Acute Care, And Critical Care Surgery,Hershey, PA, USA 3Penn State Children’s Hospital,Department Of Surgery, Division Of Pediatric Surgery,Hershey, PA, USA
Introduction:
The incidence of medical co-morbidities (such as hypertension, diabetes and obesity) is increasing in the general US population. Those with pre-existing co-morbidities present treatment challenges to trauma surgeons after injury, often due to unrecognized or poor control of these conditions. It is unknown how many trauma patients have a primary care provider (PCP) prior to injury and how the pre-injury PCP relationship may affect outcomes after injury. We hypothesized that patients with an established PCP would have decreased hospital length of stay (LOS), fewer ICU days, and decreased in-hospital mortality when compared to a matched population who lack a pre-injury PCP.
Methods:
From 2013 to 2019, the trauma registry of a rural Level 1 trauma center was queried for all patients greater than 18 years old (y/o). The presence of a PCP was extracted from each patient’s medical record. A case-control analysis based on age, gender, injury severity score (ISS), and mechanism was performed to create a cohort of patients with PCP’s and one without PCP’s. Differences in hospital LOS, ICU LOS, time on ventilator, and in-hospital mortality were studied. Statistical analysis was performed using SPSS and significance was defined as p <0.05.
Results:
Out of 19,096 patients in the trauma registry, 34.7% had a PCP recorded. From this population, 2,162 patients with PCP’s had exact matches to trauma patients without PCP’s (n=2,162).Mean age was 54.2 + 21.2 years. 65.2% were male. Mechanism of injury was 96% blunt, 3.7% penetrating, and 0.3% burns. Average ISS was 10.9 +/- 7.6. Mean hospital LOS was longer in trauma patients with PCP’s than those without (5.8 +/- 5.7 vs. 4.9 +/- 6.3 days, p <0.01). There was no difference in ICU LOS between the two cohorts (3.0 +/- 3.8 days vs. 3.5 +/- 5.4 days, p = 0.86). Patients with PCP’s required significantly less ventilator days than trauma patients without PCP’s (1.1 +/- 4.2 vs. 1.7 +/- 4.9 days, p <0.01). In-hospital mortality was lower in the group with a PCP (1.6% vs. 3.6%, p <0.01).
Conclusion:
Only 1/3 of trauma patients were noted to have a PCP prior to their injury. Pre-injury primary care was associated with increased length of stay, but fewer ventilator days and decreased mortality. Patients who suffer from known medical co-morbidities may be more likely to have a PCP prior to injury. However, those medical co-morbidities may contribute to longer LOS. Similarly, unknown medical co-morbidities in trauma patients without a PCP may go unrecognized until after their injury. Further prospective study of this relationship is indicated and may allow for improved strategies to promote primary care in populations prone to injury.
