Department of Clinical Research, New York University Langone Hospital, Brooklyn.
Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York.
Med Care. 2018 Dec;56(12):1035-1041. doi: 10.1097/MLR.0000000000000986.
Uninsured traumatic brain injury (TBI) patients have higher mortality than their insured counterparts. One possible reason is disparities in receipt of appropriate diagnostic imaging.
Examine the association between lack of insurance and use of diagnostic imaging.
This is a retrospective cohort study.
All adult patients admitted with severe (AIS>4 and GCS<15) TBI, in the National Trauma Data Bank 2010-2015.
Primary outcome was receipt of head computed tomography (CT) and number of CT scans received. Secondary outcomes included head x-ray, angiography, or magnetic resonance imaging. Patients were classified as uninsured if their payment method was self-pay or not billed.
Of 59,540 patients meeting inclusion criteria, 18.9% were uninsured. After adjusting for demographic, clinical, and facility characteristics, compared with patients with any insurance, 4.47 per 100 (95% confidence interval, 1.60-7.34) fewer uninsured patients had a head CT, with uninsured patients receiving 13% (95% confidence interval, 3-21) fewer head CTs. There were no differences in x-ray, angiography, or magnetic resonance imaging receipt.
Findings suggest lower receipt of guideline-indicated head CT among uninsured TBI patients. Mechanisms could include unconscious provider bias or institutional financial constraints. Further research is warranted to elucidate mechanisms and assess mediation by diagnostic imaging use of the insurance-mortality association.
未参保的创伤性脑损伤（TBI）患者的死亡率高于参保患者。一个可能的原因是在接受适当的诊断成像方面存在差异。
研究缺乏保险与诊断成像使用之间的关系。
这是一项回顾性队列研究。
2010-2015 年国家创伤数据库中所有因严重 TBI（AIS>4 和 GCS<15）入院的成年患者。
主要结局是接受头部计算机断层扫描（CT）和接受的 CT 扫描次数。次要结局包括头部 X 光、血管造影或磁共振成像。如果患者的支付方式是自付或未计费，则将其归类为未参保。
在符合纳入标准的 59540 名患者中，有 18.9%的患者未参保。在调整了人口统计学、临床和医疗机构特征后，与有任何保险的患者相比，每 100 名患者中就有 4.47 名（95%置信区间，1.60-7.34）未参保患者未接受头部 CT 检查，未参保患者接受的头部 CT 检查减少了 13%（95%置信区间，3-21）。X 光、血管造影或磁共振成像的接受情况没有差异。
研究结果表明，未参保 TBI 患者接受指南推荐的头部 CT 检查的比例较低。机制可能包括无意识的提供者偏见或机构财务限制。需要进一步研究以阐明机制，并评估诊断成像使用对保险-死亡率关联的中介作用。
