Disparities in trauma: the impact of socioeconomic factors on outcomes following traumatic hollow viscus injury
Disparities in trauma: the impact of socioeconomic factors on outcomes following traumatic hollow viscus injury
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DOI：
10.1016/j.jss.2013.05.052
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发表时间：
2014-09-01
影响因子：
2.2
通讯作者：
Guillamondegui, Oscar D.
中科院分区：
文献类型：
--
作者：
Hazlitt, Melissa;Hill, J. Bradford;Guillamondegui, Oscar D.
背景：这篇文章旨在研究空心内脏损伤（HVI）和社会经济因素在决定结果之间的关系。HVI具有明确的损伤模式，具有复杂的术后恢复期和发病率，是识别同质损伤人群中潜在差异的理想焦点。材料和方法：一项回顾性研究纳入了2000-2009年在美国外科医师学会创伤登记处确认的HVI I级创伤中心收治的患者。排除伴有明显实体器官或血管损伤的患者。美国人口普查（2000）家庭收入中位数按邮政编码被用作社会经济指标。人口统计学和伤害相关变量也包括在内。终点是与HVI发病率相关的死亡率和结局。结果：共发现933例HVI患者，256例符合纳入标准。有23例死亡（9.0%），死亡率与种族、性别、收入或付款人来源无关。然而，较低的家庭收入中位数与较长的取口间隔显著相关（P = 0.032）。此外，私人支付者的吻合口漏率（0%[0/73]对7.1% [13/183],P = 0.019）和筋膜开裂率（5.5%[4/73]对16.9% [31/183],P = 0.016）显著低于私人支付者，而自我支付者的脓肿形成率（24%[24/100]对10.2% [16/156],P = 0.004）和穿透性损伤（27.4%[23/84]对13.6% [12/88],P = 0.036）均显著高于私人支付者。结论：社会经济地位可能不会影响空心内脏损伤创伤患者的总体死亡率，但私人保险似乎可以保护吻合口漏、筋膜开裂和脓肿形成相关的发病率。这支持社会经济差异可能存在于长期结果中，特别是在付款人来源方面。(C) 2014爱思唯尔公司版权所有。
Background: This piece aims to examine the relationships between hollow viscus injury (HVI) and socioeconomic factors in determining outcomes. HVI has well-defined injury patterns with complex postoperative convalescence and morbidity, representing an ideal focus for identifying potential disparities among a homogeneous injury population.Materials and methods: A retrospective review included patients admitted to a level I trauma center with HVI from 2000-2009, as identified in the Trauma Registry of the American College of Surgeons. Patients with concomitant significant solid organ or vasculature injury were excluded. US Census (2000) median household income by zip code was used as socioeconomic proxy. Demographic and injury-related variables were also included. Endpoints were mortality and outcomes associated with HVI morbidity.Results: A total of 933 patients with HVI were identified and 256 met inclusion criteria. There were 23 deaths (9.0%), and mortality was not associated with race, gender, income, or payer source. However, lower median household income was significantly associated with longer intervals to ostomy takedown (P = 0.032). Additionally, private payers had significantly lower rates of anastomotic leak (0% [0/73] versus 7.1% [13/183], P = 0.019) and fascial dehiscence (5.5% [4/73] versus 16.9% [31/183], P = 0.016), while self-payers had significantly higher rates of abscess formation, both overall (24% [24/100] versus 10.2% [16/156], P = 0.004) and among penetrating injuries (27.4% [23/84] versus 13.6% [12/88], P = 0.036).Conclusions: Socioeconomic status may not impact overall mortality among trauma patients with hollow viscus injuries, but private insurance appears to be protective of morbidity related to anastomotic leak, fascial dehiscence, and abscess formation. This supports that socioeconomic disparity may exist within long-term outcomes, particularly regarding payer source. (C) 2014 Elsevier Inc. All rights reserved.