Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
Am J Surg. 2010 Apr;199(4):554-7. doi: 10.1016/j.amjsurg.2009.11.005.
Patients with penetrating injuries are known to have worse outcomes than those with blunt trauma. We hypothesize that within each injury mechanism there should be no outcome difference between insured and uninsured patients.
The National Trauma Data Bank version 7 was analyzed. Patients aged 65 years and older and burn patients were excluded. The insurance status was categorized as insured (private, government/military, or Medicaid) and uninsured. Multivariate analysis adjusted for insurance status, mechanism of injury, age, race, sex, injury severity score, shock, head injury, extremity injury, teaching hospital status, and year.
A total of 1,203,243 patients were analyzed, with a mortality rate of 3.7%. The death rate was significantly higher in penetrating trauma patients versus blunt trauma patients (7.9% vs 3.0%; P < .001), and higher in the uninsured (5.3% vs 3.2%; P < .001). On multivariate analysis, uninsured patients had an increased odds of death than insured patients, in both penetrating and blunt trauma patients. Penetrating trauma patients with insurance still had a greater risk of death than blunt trauma patients without insurance.
Insurance status is a potent predictor of outcome in both penetrating and blunt trauma.
已知穿透性损伤患者的预后比钝性创伤患者差。我们假设在每种损伤机制中，参保和未参保患者之间的预后不应存在差异。
对第 7 版国家创伤数据库进行了分析。排除了年龄在 65 岁及以上和烧伤患者。保险状况分为参保（私人、政府/军队或医疗补助）和未参保。多变量分析调整了保险状况、损伤机制、年龄、种族、性别、损伤严重程度评分、休克、头部损伤、四肢损伤、教学医院状况和年份。
共分析了 1,203,243 例患者，死亡率为 3.7%。穿透性创伤患者的死亡率明显高于钝性创伤患者（7.9% vs 3.0%；P <.001），未参保患者的死亡率明显高于参保患者（5.3% vs 3.2%；P <.001）。多变量分析显示，在穿透性和钝性创伤患者中，未参保患者的死亡风险高于参保患者。有保险的穿透性创伤患者的死亡风险仍高于无保险的钝性创伤患者。
在穿透性和钝性创伤中，保险状况是预后的一个有力预测因素。
