Charles Briggs, Tze-Woei Tan, Denis Rybin, Gheorghe Doros, Robert Eberhardt, Naomi M. Hamburg, Alik Farber
Boston Medical Center, Boston, MA.
OBJECTIVES: We sought to evaluate the impact of race on mortality and treatment approaches in vascular trauma.
METHODS: We performed a retrospective review of adult patients with traumatic vascular injury in the National Trauma Data Bank (2002-2009) based on ICD-9 codes. We categorized patients by race (white, black, or Hispanic) and identified open vascular and endovascular procedures by CPT codes. Primary outcome was in-hospital mortality.
RESULTS: Among the 25,638 cases of vascular injury, 32% of the patients were black and 18% were Hispanic. Fifty-eight percent were penetrating injuries. Injury severity score was similar across racial groups. Black and Hispanic patients were more likely to sustain penetrating injuries (81% and 67%, respectively) compared to white patients (40%, p<.001). Black patients had the highest in-hospital mortality after both blunt and penetrating injuries (22%; 19%) as compared to Hispanic patients (18%; 16%) and white patients (11%, p<0.001; 16%, p=0.005). After adjusting for demographics, injury characteristics, insurance status, and procedure type, Black race remained associated with higher mortality compared to white race in blunt (OR 1.45 95% CI 1.17, 1.81, p<.001) and penetrating (OR 1.53, 95% CI 1.25, 1.88, p<.0001) injuries. Over the study period, we observed a trend of increasing endovascular and decreasing open surgical treatment of blunt injuries that was similar across racial groups. In penetrating trauma, overall open surgical procedures were less frequent and endovascular repair more frequent in black patients.
CONCLUSIONS: Black patients have worse outcomes and increased risk of mortality after vascular trauma. Racial differences were not fully attributable to differences in injury type, severity, insurance status or treatment strategies. Trends in endovascular therapy for blunt vascular trauma are similar across racial groups. Further studies are needed to optimize therapeutic approaches to reduce racial disparities in vascular trauma.
AUTHOR DISCLOSURES: C. Briggs, Nothing to disclose; G. Doros, Nothing to disclose; R. Eberhardt, Nothing to disclose; A. Farber, Nothing to disclose; N. M. Hamburg, Nothing to disclose; D. Rybin, Nothing to disclose; T. Tan, Nothing to disclose
Posted April 2012