A Cohort Study of Emergency Department Trauma Evaluation and Outcomes by Incarceration Status

People experiencing incarceration (PEI) have high rates of trauma and emergency department (ED) utilization, yet limited data describe their ED evaluation and outcomes. We sought to compare trauma patient characteristics, ED care, and disposition by incarceration status. We hypothesized PEI would have shorter ED lengths-of-stay (LOSs), undergo more cross-sectional imaging, and have lower rates of admission. We conducted a single-center retrospective cohort study of adult incarcerated and nonincarcerated trauma patients presenting to a Level 1 trauma center from 1/2010 to 12/2020. The primary outcome was ED LOS. Patient characteristics were described, and multivariable median and logistic regression were used to compare outcomes. The cohort included 535 patients. Seventy-nine percent were male; 40% were Black, 32% Hispanic, and 18% White. On univariable analysis, PEI had lower triage acuity, had more blunt injuries, were more likely to receive imaging, and had lower rates of admission. After adjustment, PEI had a shorter median ED LOS (-1.08 hours; 95% CI: [-1.90, -0.26]; p = .01), higher odds of imaging (OR: 1.98; 95% CI: [1.18, 3.33]; p = .01), and similar admission odds (p = .55). PEI with trauma had lower-acuity visits and shorter ED LOS but underwent more imaging, suggesting more extensive evaluation. Further studies are needed to explore reasons for increased imaging in lower-acuity PEI visits and develop ED best practice guidelines.