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拉丁裔患者创伤护理的差异:按创伤中心认证级别进行的分析

Disparities in Trauma Care for Latino Patients: An Analysis by Trauma Center Verification Level.

作者信息

Scally Gabriel, Orozco Jesus, Tovar Hirashima Eva, Sheets Nicholas W

机构信息

General Surgery, HCA Healthcare Riverside, Riverside, USA.

School of Medicine, University of California Riverside School of Medicine, Riverside, USA.

出版信息

Cureus. 2024 Dec 23;16(12):e76282. doi: 10.7759/cureus.76282. eCollection 2024 Dec.

Abstract

Introduction Trauma is the leading cause of death for individuals under 45 in the United States (US), with significant disparities in outcomes among minority groups. Latinos, the largest ethnic minority in the US, often face barriers to optimal trauma care that may require additional resources. This study aimed to compare trauma outcomes for Latino patients treated at Level I versus Level II/III trauma centers (TCs). Methods We conducted a retrospective analysis using the National Trauma Data Bank (NTDB) from 2019 to 2021. Latino patients aged ≥ 18 years treated at Level I and Level II/III TCs were included. The primary outcome was in-hospital mortality, while secondary outcomes included length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, in-hospital complications, and discharge disposition. Propensity score matching was used to control for age, sex, injury severity, and mechanism of injury. Statistical analyses were performed with a significance level of < 0.05. Results The unmatched cohort included 221,050 Latino patients, with 139,286 treated at Level I and 81,764 at Level II/III TCs. After matching, 81,764 patients remained in each group. Level I TCs had lower mortality (1.26% vs. 1.48%; < 0.05) and higher discharge-to-home rates (75.22% vs. 73.15%; < 0.05) yet had longer hospital LOS (6.53 ± 0.03 vs. 6.17 ± 0.03; < 0.05), ICU LOS (5.56 ± 0.05 vs. 5.13 ± 0.04; < 0.05), and more in-hospital complications (3.92% vs. 3.67%;  < 0.05). Conclusion Despite similar baseline characteristics, Latino patients treated at Level I TCs had better survival and disposition outcomes but experienced longer LOS and higher complication rates. While resource availability largely determines trauma verification level and may be responsible for disparities in care, more studies are needed to investigate further how verification level impacts care for Latino patients.

摘要

引言

创伤是美国45岁以下人群的主要死因,少数族裔群体在创伤治疗结果方面存在显著差异。拉丁裔是美国最大的少数族裔,他们在获得最佳创伤治疗方面常常面临障碍,这可能需要额外的资源。本研究旨在比较在一级创伤中心与二级/三级创伤中心接受治疗的拉丁裔患者的创伤治疗结果。

方法

我们使用2019年至2021年的国家创伤数据库(NTDB)进行了一项回顾性分析。纳入了在一级和二级/三级创伤中心接受治疗的年龄≥18岁的拉丁裔患者。主要结局是住院死亡率,次要结局包括住院时间(LOS)、重症监护病房(ICU)住院时间、呼吸机使用天数、住院并发症和出院处置情况。采用倾向评分匹配法来控制年龄、性别、损伤严重程度和损伤机制。统计分析的显著性水平设定为<0.05。

结果

未匹配的队列包括221,050名拉丁裔患者,其中139,286名在一级创伤中心接受治疗,81,764名在二级/三级创伤中心接受治疗。匹配后,每组各有81,764名患者。一级创伤中心的死亡率较低(1.26%对1.48%;<0.05),出院回家率较高(75.22%对73.15%;<0.05),但住院LOS更长(6.53±0.03对6.17±0.03; <0.05),ICU住院时间更长(5.56±0.05对5.13±0.04;<0.05),住院并发症更多(3.92%对3.67%;<0.05)。

结论

尽管基线特征相似,但在一级创伤中心接受治疗的拉丁裔患者有更好的生存和处置结果,但住院时间更长,并发症发生率更高。虽然资源可用性在很大程度上决定了创伤认证水平,可能是导致治疗差异的原因,但还需要更多研究进一步调查认证水平如何影响拉丁裔患者的治疗。

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