Missios Symeon, Bekelis Kimon
Department of Surgery, Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, USA.
Department of Neurosurgery, Louisiana State University Health Sciences Center, 1541 Kings Hwy, Shreveport, LA 71103, USA.
Spine J. 2015 Sep 1;15(9):2028-35. doi: 10.1016/j.spinee.2015.05.017. Epub 2015 May 19.
The influence of nonmedical factors on the disposition of spine trauma patients, initially seen in less specialized institutions, remains an issue of debate.
To investigate the association of lack of insurance and African-American race with the probability of being transferred to a Level I or II trauma center, after being evaluated in the emergency department (ED) of Level III or IV trauma centers for spine trauma.
STUDY DESIGN/SETTING: This was a retrospective cohort study.
A total of 14,133 patients who were registered in National Trauma Data Bank (NTDB) from 2009 to 2011 and initially evaluated in the ED of Level III or IV trauma centers for spine trauma were included.
The outcome measures were rates of transfer to a higher level of care trauma center.
We performed a retrospective cohort study involving spine trauma patients, who were registered in the NTDB between 2009 and 2011. Regression techniques, controlling for clustering at the hospital level, were used to investigate the association of insurance status and race with the possibility of transfer.
Overall, 4,142 patients (29.31%) were transferred to a higher level of care institution, and 9,738 (70.69%) were admitted to a Level III or IV trauma center. Multivariable logistic regression analysis demonstrated an association of uninsured patients with increased possibility of transfer (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.22-1.61). This persisted after using a mixed effects model to control for clustering at the hospital level (OR, 1.65; 95% CI, 1.37-1.96). African-American race was not associated with the decision to transfer, when using a mixed effects model (OR, 1.15; 95% CI, 0.89-1.48). However, African-Americans with Glasgow Coma Scale greater than 8 (OR, 1.40; 95% CI, 1.13-1.74) or Injury Severity Score less than 15 (OR, 1.54; 95% CI, 1.21-1.96) were associated with a higher likelihood of transfer.
In summary, lack of insurance was associated with increased possibility of transfer to higher level of care institutions, after evaluation in a Level III or IV trauma center ED for spine trauma. The same was true for African-Americans with milder injuries.
非医学因素对脊柱创伤患者处置的影响最初在不太专业的机构中被观察到，目前仍是一个有争议的问题。
在三级或四级创伤中心急诊科对脊柱创伤进行评估后，调查缺乏保险和非裔美国人种族与转至一级或二级创伤中心可能性之间的关联。
研究设计/地点：这是一项回顾性队列研究。
纳入了2009年至2011年在国家创伤数据库（NTDB）登记且最初在三级或四级创伤中心急诊科接受脊柱创伤评估的总共14133例患者。
结局指标是转至更高护理级别的创伤中心的比例。
我们对2009年至2011年在NTDB登记的脊柱创伤患者进行了一项回顾性队列研究。使用回归技术并控制医院层面的聚类情况，以调查保险状况和种族与转院可能性之间的关联。
总体而言，4142例患者（29.31%）被转至更高护理级别的机构，9738例（70.69%）被收治于三级或四级创伤中心。多变量逻辑回归分析表明，未参保患者转院可能性增加（比值比[OR]，1.40；95%置信区间[CI]，1.22 - 1.61）。在使用混合效应模型控制医院层面的聚类情况后，这一情况依然存在（OR，1.65；95%CI，1.37 - 1.96）。在使用混合效应模型时，非裔美国人种族与转院决策无关（OR，1.15；95%CI，0.89 - 1.48）。然而，格拉斯哥昏迷量表大于8分（OR，1.40；95%CI，1.13 - 1.74）或损伤严重度评分小于15分的非裔美国人转院可能性更高（OR，1.54；95%CI，1.21 - 1.96）。
总之，在三级或四级创伤中心急诊科对脊柱创伤进行评估后，缺乏保险与转至更高护理级别机构的可能性增加相关。伤势较轻的非裔美国人情况也是如此。
