Ethnic Disparities in Initial Management of Trauma Patients in a Nationwide Sample of Emergency Department Visits
Ethnic Disparities in Initial Management of Trauma Patients in a Nationwide Sample of Emergency Department Visits
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DOI：
10.1001/archsurg.143.11.1057
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发表时间：
2008-11-01
影响因子：
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通讯作者：
Gentilello, Larry M.
中科院分区：
文献类型：
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作者：
Shafi, Shahid;Gentilello, Larry M.
假设：创伤性脑损伤后功能结局的种族差异已被证实。然而，目前尚不清楚这些差异是由于获得初始诊断和治疗方式的机会不同，还是由于资金不足的市中心急诊室提供的不成比例的护理。我们假设急诊室对受伤患者的初步评估受患者种族的影响。设计：回溯性数据库分析。地点：数据来自2003年国家医院非卧床医疗护理调查ED部分，其中包括全国急诊就诊的概率抽样调查。患者：包括15岁及以上患者所有与伤害相关的首次急诊。将患者分为3组：非西班牙裔白人(n=6106)、非裔美国人(n=1406)和西班牙裔美国人(n=1051)。主要观察指标：比较3组患者的ED评估和管理强度以及患者对ED的处置。结果：与非西班牙裔白人患者相比，少数族裔患者略年轻，更不可能获得保险，但在性别、伤害机制和伤害严重程度方面相似。非西班牙裔白人患者与两个少数民族之间在ED评估、诊断和治疗方式以及ED倾向方面没有显著的临床差异。结论：在全国具有代表性的急诊样本中，少数族裔受伤患者的初始评估和处理与非西班牙裔白人患者相似。应该寻找导致受伤后预后不同的其他原因。
Hypothesis: Ethnic disparities in functional outcomes after traumatic brain injuries have been demonstrated previously. However, it is not clear if these disparities are due to differential access to initial diagnostic and treatment modalities or disproportionate care at poorly funded inner-city emergency departments (EDs). We hypothesized that initial assessment of injured patients in EDs is affected by patient ethnicity.Design: Retrospective database analysis.Setting: Data were obtained from the National Hospital Ambulatory Medical Care Survey ED component for 2003, which includes a national probability sample survey of ED visits.Patients: All injury-related initial ED visits of patients 15 years and older were included. Patients were divided into 3 groups: non-Hispanic white (n = 6106), African American (n = 1406), and Hispanic (n = 1051).Main Outcome Measures: The intensity of ED assessment and management and patient disposition from EDs were compared in the 3 groups.Results: Compared with non-Hispanic white patients, minority patients were slightly younger and less likely to be insured but were similar in sex, mechanism of injury, and injury severity. There were no clinically significant differences between non-Hispanic white patients and the 2 minority groups in ED assessment, diagnostic and treatment modalities, and ED disposition. There were no systematic differences by region of the country, ownership of the hospitals, or insurance status of the patients.Conclusion: The initial assessment and management of injured patients from ethnic/racial minorities was similar to that of non-Hispanic white patients in a nationwide representative sample of ED visits. Other causes of ethnic disparities in outcomes after injuries should be sought.