Are there racial disparities in trauma care?

A number of recent studies have demonstrated disparity between racial groups in both outcome and processes of trauma care. These were not controlled for the presence of shock.

We used data from the National Trauma Databank (NTDB) (version 6.0) to evaluate mortality, length of hospital stay, and discharge disposition for patients who suffered gunshot wounds (GSW) or who were drivers in motor vehicle crashes (MVC). Using regression analysis to control for age, gender, first measured systolic blood pressure, geographic region, trauma center verification status, and hospital teaching status, we looked for differences in trauma care outcomes by race as represented in the NTDB.

We included 235,557 MVC victims and 13,378 GSW victims in our analysis. When potential confounding variables were accounted for, there were no differences in mortality based on race in either group, with the exception that Hispanic motor vehicle drivers suffered higher mortality, OR: 1.72 (95% CI: 1.36, 2.19; p<.001). Both Blacks and Hispanics had shorter lengths of stay in linear regression models (p<.001 in both cases) than whites. Blacks and Hispanics were less likely to be discharged home when compared to white patients (OR 0.83, 95% CI 0.80-0.86 for Blacks, and OR 0.53, 95% CI 0.50-0.56 for Hispanics). Shock, as reflected by first systolic blood pressure reported, and to a lesser degree, anatomic injury, as measured by Injury Severity Score (ICISS), were much more powerful predictors of outcome than race in all analyses.

We found no mortality differences based on race for GSW. Hispanics have a higher mortality rate for MVC. For both injury types, Blacks and Hispanics had shorter hospital stays and a greater likelihood of transfer to post-acute care when compared to white patients. Hypotension on admission has a much more significant impact on outcome than race and ethnicity.