Orthopaedic emergencies - associations between race, gender, insurance type, and hospital admission

For many, the emergency department (ED) serves as a critical entry point into the healthcare system. The purpose of this study was to investigate whether race, ethnicity, gender, or insurance were associated with hospital admission from the ED in the setting of an orthopaedic emergency.

This retrospective cohort analysis included all patients who presented to the ED with an orthopaedic emergency during a one-year period. Injury data were collected from an internal database of orthopaedic consultations. Injury verification, as well as admission status, race, ethnicity, age, gender, body mass index (BMI), and type of insurance were extracted from the medical record.

A total of 4328 patients were included. On univariate analysis, older patients (mean age 58, rather than 52, P < 0.01), White as compared to Black (P < 0.01), and ethnically non-Hispanic patients (P < 0.01) were significantly more likely to be admitted to the hospital. On multivariate analysis that controlled for type of orthopaedic injury, White race, Medicaid or no insurance, and older age were significantly predictive of orthopaedic admission (all P < 0.05). On marginal analysis that accounted for type of orthopaedic injury, a White, male patient was noted to have a 10% higher probability of admission (49%, P > 0.01) following orthopaedic evaluation than a Black, female patient (39%, P > 0.01).

This study demonstrates that even accounting for type of orthopaedic injury, race, age, and insurance are independently associated with hospital admission in the setting of orthopaedic emergencies.