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Outcomes after emergency general surgery and trauma care in incarcerated individuals: An EAST multicenter study
Mary K Bryant1, Leah C Tatebe, Nandini Rajaram Siva
1From the Department of Surgery (M.K.B., M.W., E.B.D., S.S.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Trauma and Burn Surgery (L.C.T., N.R.S.), Cook County Health, Rush University Midwestern University, Chicago, Illinois; Department of Surgery (M.K.B., P.O.U.), WakeMed Health and Hospitals, Raleigh, North Carolina; Department of Surgery (M.L.C., Y.D.Z.), University of Florida Jacksonville, Jacksonville, Florida; Department of Surgery (V.T., A.S.), Texas Tech University Health Sciences Center, Lubbock, Texas; Department of Surgery (C.K., D.T.), Loma Linda University Medical Center (LLUMC), Loma Linda, California; Department of Surgery (K.D.N., S.T.), University Medical Center, Tulane University, New Orleans, Louisiana; Department of Surgery (A.S., R.G.M.), Harborview Medical Center, University of Washington, Seattle, Washington; Department of Surgery (M.A., P.P.), Albany Medical College, Albany, New York; Department of Surgery (T.J.S., J.R.), University of Colorado, Colorado Springs, Colorado; Department of Surgery (L.Z.K., M.A.B.), Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California; and Department of Surgery (S.B., A.T.), University Hospital-Newark, Rutgers, The State University of New Jersey, Newark, New Jersey.
Background:
The US incarcerates more individuals than any other country. Prisoners are the only population guaranteed health care by the US constitution, but little is known about their surgical needs. This multicenter study aimed to describe the acute care surgery (ACS) needs of incarcerated individuals.
Methods:
Twelve centers prospectively identified incarcerated patients evaluated in their emergency department by the ACS service. Centers collected diagnosis, treatment, and complications from chart review. Patients were classified as either emergency general surgery (EGS) patients or trauma patients and their characteristics and outcomes were investigated. Poisson regression accounting for clustering by center was used to calculate the relative risk (RR) of readmission, representation within 90 days, and failure to follow-up as an outpatient within 90 days for each cohort.
Results:
More than 12 months, ACS services evaluated 943 patients, 726 (80.3%) from jail, 156 (17.3%) from prison, and 22 (2.4%) from other facilities. Most were men (89.7%) with a median age of 35 years (interquartile range, 27-47). Trauma patients comprised 54.4% (n = 513) of the cohort. Admission rates were similar for trauma (61.5%) and EGS patients (60.2%). Head injuries and facial fractures were the most common injuries, while infections were the most common EGS diagnosis. Self-harm resulted in 102 trauma evaluations (19.9%). Self-inflicted injuries were associated with increased risk of readmission (RR, 4.3; 95% confidence interval, 3.02-6.13) and reevaluation within 90 days (RR, 4.96; 95% confidence interval, 3.07-8.01).
Conclusion:
Incarcerated patients who present with a range of trauma and EGS conditions frequently require admission, and follow-up after hospitalization was low at the treating center. Poor follow-up coupled with high rates of assault, self-harm, mental health, and substance use disorders highlight the vulnerability of this population. Hospital and correctional facility interventions are needed to decrease self-inflicted injuries and assaults while incarcerated.
Level Of Evidence:
Prognostic and epidemiological, Level III.
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