Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
Am J Prev Med. 2018 Nov;55(5 Suppl 1):S5-S13. doi: 10.1016/j.amepre.2018.05.007.
Racial disparities have been both published and disputed in trauma patient mortality, outcomes, and rehabilitation. In this study, the objective was to assess racial disparities in patients with penetrating colon trauma.
The National Trauma Data Bank was searched for males aged ≥14years from 2010 through 2014 who underwent operative intervention for penetrating colon trauma. The primary outcomes for this study were stoma formation and transfer to rehabilitation; secondary outcomes were postoperative morbidity and mortality. Analyses were performed in 2016-2018.
There were 7,324 patients identified (4,916 black, 2,408 white). Black and white patients underwent fecal diversion with stoma formation at a similar rate (19.6% vs 18.5%, p=0.28). Black patients were more likely than white patients to be uninsured (self-pay; 37.1% vs 29.9%) and more likely to be injured by firearms (88.3% vs 70.2%, p<0.001), but had a lower overall postoperative morbidity rate (52.6% vs 55.3%, p=0.04). The odds of stoma formation (OR=0.92, 95% CI=0.78, 1.09, p=0.35) and the odds of transfer to rehabilitation (OR=1.03, 95% CI=0.82, 1.30, p=0.78) were similar for black versus white patients.
Black patients experienced similar rates of stoma formation and transfer to rehabilitation as white patients with penetrating colon trauma. Multivariate analysis confirmed expected findings that trauma severity increased the odds of receiving an ostomy and rehabilitation placement. The protocol-based management approach to emergency trauma care potentially decreases the risk for the racial biases that could lead to healthcare disparities.
This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
在创伤患者的死亡率、结局和康复方面，种族差异已经得到了发表和争议。本研究的目的是评估穿透性结肠外伤患者的种族差异。
从 2010 年至 2014 年，国家创伤数据库搜索了年龄≥14 岁的男性，他们接受了穿透性结肠外伤的手术干预。本研究的主要结局是造口形成和转至康复；次要结局是术后发病率和死亡率。分析于 2016-2018 年进行。
共确定了 7324 名患者（4916 名黑人，2408 名白人）。黑人患者和白人患者进行粪便转流造口形成的比例相似（19.6%比 18.5%，p=0.28）。黑人患者比白人患者更有可能没有保险（自付；37.1%比 29.9%），更有可能被枪支所伤（88.3%比 70.2%，p<0.001），但总体术后发病率较低（52.6%比 55.3%，p=0.04）。黑人和白人患者的造口形成（OR=0.92，95%CI=0.78，1.09，p=0.35）和转至康复（OR=1.03，95%CI=0.82，1.30，p=0.78）的几率相似。
黑人患者经历穿透性结肠外伤后，与白人患者的造口形成和转至康复的几率相似。多变量分析证实了预期的发现，即创伤严重程度增加了接受造口和康复安置的几率。基于方案的紧急创伤护理管理方法可能降低导致医疗保健差异的种族偏见的风险。
本文是国家卫生研究院赞助的题为“非裔美国男性健康：研究、实践和政策影响”的补充文章的一部分。
