@article{ref1,
title="Regional, racial, and mortality disparities associated with neurosurgeon staffing at level I trauma centers",
journal="American surgeon",
year="2020",
author="Homo, Richelle L. and Grigorian, Areg and Chen, Jefferson and Figueroa, Cesar and Chin, Theresa and Kuza, Catherine M. and Lekawa, Michael and Nahmias, Jeffry",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Traumatic brain injury (TBI) occurs in approximately 30% of trauma patients. Because neurosurgeons hold expertise in treating TBI, increased  neurosurgical staffing may improve patient outcomes. We hypothesized that TBI  patients treated at level I trauma centers (L1TCs) with ≥3 neurosurgeons have a  decreased risk of mortality vs. those treated at L1TCs with <3 neurosurgeons. <br><br>METHODS: The Trauma Quality Improvement Program database (2010-2016) was queried for  patients ≥18 years with TBI. Patient characteristics and mortality were compared  between ≥3 and <3 neurosurgeon-staffed L1TCs. A multivariable logistic regression  analysis was used to identify risk factors associated with mortality. <br><br>RESULTS:  Traumatic brain injury occurred in 243 438 patients with 5188 (2%) presenting to  L1TCs with <3 neurosurgeons and 238 250 (98%) to L1TCs with ≥3 neurosurgeons. Median  injury severity score (ISS) was similar between both groups (17, P =.09). There  were more Black (37% vs. 12%, P <.001) and Hispanic (18% vs. 12%, P <.001)  patients in the <3 neurosurgeon group. Nearly 60% of L1TCs with <3 neurosurgeons are  found in the South. Mortality was higher in the <3 vs. the ≥3 group (12% vs. 10%, P  <.001). Patients treated in the <3 neurosurgeon group had a higher risk for  mortality than those treated in the ≥3 neurosurgeon group (odds ratio (OR) 1.13, 95%  confidence intervals (CI) 1.01-1.26, P =.028). <br><br>DISCUSSION: There exists a  significant racial disparity in access to neurosurgeon staffing with additional  disparities in outcomes based on staffing. Future efforts are needed to improve this  chasm of care that exists for trauma patients of color.<p /> <p>Language: en</p>",
language="en",
issn="0003-1348",
doi="10.1177/0003134820983187",
url="http://dx.doi.org/10.1177/0003134820983187"
}