M. Arafeh1, S. Selvarajah1, E. B. Schneider1, J. Canner1, C. K. Zogg1, A. H. Haider1 1Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research, Department Of Surgery,Baltimore, MD, USA
Introduction: Variations in in-hospital mortality rates by socioeconomic status (SES) following trauma have been consistently demonstrated, but mechanisms underlying this disparity are poorly understood. We sought to evaluate the impact of SES on the occurrence of post-traumatic complications and subsequent failure-to-rescue (FTR).
Methods: A retrospective analysis of the 2006-2011 Nationwide Emergency Department Sample (NEDS) was performed. Patients aged 18-64 years presenting to Level I or II trauma centers with blunt traumatic injury were identified. SES was determined using a pre-defined NEDS variable classifying patients into quartiles of median household income by zip code. A nationally representative weighted population subset was used, approximating a 20% stratified sample of U.S. hospital-based emergency departments. [t1] Complications associated with FTR as defined by the Agency for Healthcare Research & Quality (AHRQ) were identified using ICD-9 diagnosis codes. Multivariable logistic regression was performed to determine the odds of FTR (defined as mortality following a specified complication) comparing patients from the lowest SES (Q1) with patients from the highest SES (Q4), adjusting for age, gender, insurance status, injury severity, comorbidities, trauma level, and teaching status.
Results: Of 412,534 cases that met inclusion criteria, 22,398 (5.4%) patients had one or more complication. Overall, proportionally more patients in Q1 (n=13,964; 5.8%) developed complications compared with patients in Q4 (n=8,474; 5.0%), p=0.002. Of patients who developed complications, the average patient age was 44 years (SE=0.252); 76.8% were males with equal distribution between Q1 and Q4 (p=0.799). FTR was proportionally more common among patients in Q1 compared to Q4 (19.5% vs. 15.4%; p=0.004). After adjusting for relevant covariates, the odds of FTR were 31% higher among patients in Q1 compared to Q4 (AOR=1.31 [95% CI=1.067-1.620], p=0.012).
Conclusion: Among patients who develop complications, FTR is significantly increased following blunt traumatic injury in the lowest SES quartile (Q1) compared to the wealthiest patients (Q4). Further research will be necessary to discern factors associated with higher complication and greater FTR rates among patients with low SES.