Disparities in discharge patterns of admitted older patients with ocular trauma.
In older patients, poor vision from ocular trauma increases the likelihood of further injuries and repeat hospitalizations, underscoring the need for appropriate post-hospitalization care. We sought to evaluate disposition patterns of older patients admitted with ocular trauma.
This retrospective observational study analyzed the National Trauma Data Bank (2008-2014) and de-identified data of patients, ≥65 years old, admitted with ocular trauma were identified using ICD-9CM and E-codes. Age, gender, race/ethnicity, type of ocular injury, comorbidities, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, length of hospital stay, location and US region, insurance, and discharge disposition were extracted. Analysis was performed with student's t-test, Chi-squared test, and odds ratios (OR) using SPSS software. Statistical significance was set at P <.05.
58,074 (18.3%) of 316,485 patients admitted with ocular trauma were >65yrs. 26,346 (45.4%) were discharged home and 23,314 (40.1%) to an advanced care facility (ACF). Nursing home residents were most likely to return to ACF (OR, 4.76; 95%CI, 4.40-5.14; P < .001). Patients with severe traumatic brain injury (Glasgow coma score [GCS]<8) (OR, 4.57; 95%CI, 4.09-5.11; P < .001), very severe injury severity score (ISS ≥24) (OR, 3.73; 95%CI, 3.46-4.01; P < .001), females (OR, 1.27; 95%CI, 1.23-1.32; P < .001), white patients (OR, 1.29; 95%CI, 1.24-1.36; P < .001) and Medicare beneficiaries (OR, 1.14; 95%CI, 1.09-1.19; P < .001) were most likely to be discharged to an ACF. Demography-related discharge propensities prevailed nationwide and within insurance categories. Multivariate regression analysis revealed factors determining ACF placement were, in order: length of hospital stay, nursing home residency, GCS<8, ISS>24, female gender, white race, and Medicare insurance.
Hispanic, black, male, and self-paying patients were disproportionately discharged home. Ocular injuries had low impact on ACF placement. Understanding these disparities will assist in developing guidelines for appropriate and equitable post-trauma rehabilitation in this vulnerable population.
He C
，Parsikia A
，Mbekeani JN
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Firearm trauma: Race and insurance influence mortality and discharge disposition.
Health insurance and race impact mortality and discharge outcomes in the general trauma population. It remains unclear if disparities exist by race and/or insurance in outcomes following firearm injuries. The purpose of this study was to assess differences in mortality and discharge based on race and insurance status following firearm injuries.
The National Trauma Data Bank (2007-2016) was queried for firearm injuries by International Classification of Diseases, Ninth/Tenth Revision, Ecodes. Patients with known discharge disposition, age (18-64 years), race, and insurance were included in analysis (N = 120,005). To minimize bias due to missing data, we used multiple imputation for variables associated with outcomes following traumatic injury: Injury Severity Score, Glasgow Coma Scale score, respiratory rate, systolic blood pressure, and sex. Multivariable regression analysis was additionally adjusted for age, sex, Injury Severity Score, intent, Glasgow Coma Scale score, systolic blood pressure, heart rate, respiratory rate, year, and clustered by facility to assess differences in mortality and discharge disposition.
The average age was 31 years, 88.6% were male, and 50% non-Hispanic Blacks. Overall mortality was 11.5%. Self-pay insurance was associated with a significant increase in mortality rates in all racial groups compared with non-Hispanic Whites with commercial insurance. Hispanic commercial, Medicaid, and self-pay patients were significantly less likely to discharge with posthospital care compared with commercially insured non-Hispanic Whites. When examining racial differences in mortality and discharge by individual insurance types, commercially insured non-Hispanic Black and other race patients were significantly less likely to die compared with similarly insured non-Hispanic White patients. Regardless of race, no significant differences in mortality were observed in Medicaid or self-pay patients compared with non-Hispanic White patients.
Victims of firearm injuries with a self-pay insurance status have a significantly higher rate of mortality. Hispanic patients regardless of insurance status were significantly less likely to discharge with posthospital care compared with non-Hispanic Whites with commercial insurance. Continued efforts are needed to understand and address the relationship between insurance status, race, and outcomes following firearm violence.
Prognostic and epidemiologic, Level IV.
Lumbard DC
，Freese RL
，Marek AP
，Endorf FW
，Richardson CJ
，Nygaard RM
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