Shafi Shahid, Gentilello Larry M
Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Mail Stop 9158, Dallas, TX 75390-9158, USA.
Arch Surg. 2008 Nov;143(11):1057-61; discussion 1061. doi: 10.1001/archsurg.143.11.1057.
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.
Retrospective database analysis.
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.
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).
The intensity of ED assessment and management and patient disposition from EDs were compared in the 3 groups.
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.
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.
先前已证实创伤性脑损伤后功能结局存在种族差异。然而，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科（ED）提供的护理不成比例所致。我们假设急诊科对受伤患者的初始评估受患者种族的影响。
回顾性数据库分析。
数据来自2003年国家医院门诊医疗调查的急诊科部分，其中包括对急诊科就诊的全国概率抽样调查。
纳入所有15岁及以上患者与损伤相关的首次急诊科就诊。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（n = 1051）。
比较3组患者的急诊科评估和管理强度以及急诊科的患者处置情况。
与非西班牙裔白人患者相比，少数族裔患者年龄稍小，参保可能性较低，但在性别、损伤机制和损伤严重程度方面相似。在急诊科评估、诊断和治疗方式以及急诊科处置方面，非西班牙裔白人患者与两个少数族裔组之间没有临床显著差异。在全国不同地区、医院所有权或患者保险状况方面没有系统差异。
在全国具有代表性的急诊科就诊样本中，少数族裔/种族受伤患者的初始评估和管理与非西班牙裔白人患者相似。应寻找损伤后种族差异结局的其他原因。
