TY  - JOUR
PY  - 2013//
TI  - Minority trauma patients tend to cluster at trauma centers with worse-than-expected mortality: Can this phenomenon help explain racial disparities in trauma outcomes?
JO  - Annals of surgery
A1  - Haider, Adil H.
A1  - Hashmi, Zain G.
A1  - Zafar, Syed Nabeel
A1  - Hui, Xuan
A1  - Schneider, Eric B.
A1  - Efron, David T.
A1  - Haut, Elliott R.
A1  - Cooper, Lisa A.
A1  - MacKenzie, Ellen J.
A1  - Cornwell, Edward E.
SP  - 572
EP  - 9; discussion 579
VL  - 258
IS  - 4
N2  - OBJECTIVES:: To determine whether minority trauma patients are more commonly treated at trauma centers (TCs) with worse observed-to-expected (O/E) survival. BACKGROUND:: Racial disparities in survival after traumatic injury have been described. However, the mechanisms that lead to these inequities are not well understood. METHODS:: Analysis of level I/II TCs included in the National Trauma Data Bank 2007-2010. White, Black, and Hispanic patients 16 years or older sustaining blunt/penetrating injuries with an Injury Severity Score of 9 or more were included. TCs with 50% or more Hispanic or Black patients were classified as predominantly minority TCs. Multivariate logistic regression adjusting for several patient/injury characteristics was used to predict the expected number of deaths for each TC. O/E mortality ratios were then generated and used to rank individual TCs as low (O/E <1), intermediate, or high mortality (O/E >1). RESULTS:: A total of 556,720 patients from 181 TCs were analyzed; 86 TCs (48%) were classified as low mortality, 6 (3%) intermediate, and 89 (49%) as high mortality. More of the predominantly minority TCs [(82% (22/27) vs 44% (67/154)] were classified as high mortality (P < 0.001). Approximately 64% of Black patients (55,673/87,575) were treated at high-mortality TCs compared with 54% Hispanics (32,677/60,761) and 41% Whites (165,494/408,384) (P < 0.001). CONCLUSIONS:: Minority trauma patients are clustered at hospitals with significantly higher-than-expected mortality. Black and Hispanic patients treated at low-mortality hospitals have a significantly lower odds of death than similar patients treated at high-mortality hospitals. Differences in TC outcomes and quality of care may partially explain trauma outcomes disparities.<p />  <p>Language: en</p>
LA  - en
SN  - 0003-4932
UR  - http://dx.doi.org/10.1097/SLA.0b013e3182a50148
ID  - ref1
ER  -