Abstract
Importance: Differences in time to diagnostic and therapeutic measures can contribute to disparities in outcomes. However, whether there is an association of timeliness by sex for trauma patients is unknown. Objective: To investigate whether sex-based differences in time to definitive interventions exist for trauma patients in the US and whether these differences are associated with outcomes. Design, Setting, and Participants: This was a retrospective cohort study conducted from July 2020 to July 2021, using the 2013 to 2016 Trauma Quality Improvement Program (TQIP) databases from level I to III trauma centers in the US. Patients 18 years or older with an Injury Severity Score (ISS) greater than 15 and who carried diagnoses of traumatic brain injury, intra-abdominal injury, pelvic fracture, femur fracture, and spinal injury as a result of their trauma were included in the study. Data were analyzed from July 2020 to July 2021. Main Outcomes and Measures: Primary outcomes assessed timeliness to interventions, using Wilcoxon signed rank and χ2 tests. Secondary outcomes included location of discharge after injury, using propensity score-matched generalized estimating equations modeling. Results: Of the 28332 patients included, 20002 (70.6%) were male patients (mean [SD] age, 43.3 [18.2] years) and 8330 (29.4%) were female patients (mean [SD] age, 48.5 [21.1] years), with significantly different distributions of ISS scores (ISS score 16-24: male patient, 10622 [53.1%]; female patient, 4684 [56.2%]; ISS score 41-74: male patient, 2052 [10.3%]; female patient, 852 [10.2%]). Male patients more frequently had abdominal (4257 [21.3%] vs 1268 [15.2%]) and spinal cord (3989 [20.0%] vs 1274 [15.3%]) injuries, whereas female patients experienced greater proportions of femur (3670 [44.0%] vs 8422 [42.1%]) and pelvic (3970 [47.6%] vs 6963 [34.8%]) fractures. Female patients experienced significantly longer emergency department length of stay (median [IQR], 184 [92-314] minutes vs 172 [86-289] minutes; P <.001), longer time in pretriage (median [IQR], 52 [36-80] minutes vs 49 [34-77] minutes; P <.001), and increased likelihood of discharge to nursing or long-term care facilities instead of home after matching by age, ISS, mechanism, and injury type (male patient:female patient, odds ratio, 0.72; 95% CI, 0.67-0.78). Conclusions and Relevance: Results of this cohort study suggest that female trauma patients experienced slightly longer delays in trauma care and had a higher likelihood of discharge to long-term care facilities than their male counterparts.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 609-616 |
| Number of pages | 8 |
| Journal | JAMA surgery |
| Volume | 157 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2022 |
Funding
reported receiving the American College of Surgeons Firearm Clinical Scholar Fellowship, which was funded by the American Foundation for Firearm Injury Reduction in Medicine, the Eastern Association for the Surgery of Trauma, the American College of Surgeons Committee on Trauma, the Pediatric Trauma Society, the Western Trauma Association, and the American Association for the Surgery of Trauma. Dr Reddy reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Stey reported receiving the American College of Surgeons James Carrico Faculty Research Fellowship and the American Association for the Surgery of Trauma Research and Education Fund Scholarship Award. No other disclosures were reported.
ASJC Scopus subject areas
- Surgery