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- Zebley, James A., et al.
(författare)
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Racial Disparities in Administration of Venous Thromboembolism Prophylaxis After Severe Traumatic Injuries
- 2023
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Ingår i: The American surgeon. - : Southeastern Surgical Congress. - 0003-1348 .- 1555-9823. ; 89:11, s. 4696-4706
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Race is associated with differences in quality of care process measures and incidence of venous thromboembolism (VTE) in trauma patients. We aimed to investigate if racial disparities exist in the administration of VTE prophylaxis in trauma patients.METHODS: We queried the Trauma Quality Improvement Project database from 2017 to 2019. Patients ages ≥16 years old with ISS ≥15 were included. Patients with no signs of life on arrival, any AIS ≥6, hospital length of stay <1 day, anticoagulant use before admission, or without recorded race were excluded. Patients were grouped by race: white, black, Asian, American Indian, and Native Hawaiian or Pacific Islander. The association between VTE prophylaxis administration and race was determined using a Poisson regression model with robust standard errors to adjust for confounders.RESULTS: A total of 285,341 patients were included. Black patients had the highest rates of VTE prophylaxis exposure (73.8%), shortest time to administration (1.6 days), and highest use of low molecular weight heparin (56%). Black patients also had the highest incidence of deep vein thrombosis (2.8%) and pulmonary embolism (1.4%). Black patients were 4% more likely to receive VTE prophylaxis than white patients [adj. IRR (95% CI): 1.04 (1.03-1.05), P < .001]. American Indians were 8% less likely to receive VTE prophylaxis [adj. IRR (95% CI): .92 (.88-.97), P < .001] than white patients. No differences between white and Asian or Native Hawaiian or Pacific Islander patients existed.DISCUSSION: While black patients had the highest incidence of DVT and PE, they had higher administration rates and earlier initiation of VTE prophylaxis. Further work can elucidate modifiable causes of these differences.
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| 2. |
- Zebley, James Andrew, et al.
(författare)
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Racial Disparities in the Placement of Intracranial Monitoring : A TQIP Analysis
- 2022
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Ingår i: Journal of the American College of Surgeons. - : Elsevier. - 1072-7515 .- 1879-1190. ; 235:5 Suppl. 2, s. S96-S96
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The Brain Trauma Foundation recommends intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Race is associated with worse outcomes after TBI. The reasons for racial disparities in clinical decision-making around ICP monitor placement remain unclear.Methods: We queried the Trauma Quality Improvement Project (TQIP) database from 2017-2019 and included patients ≥16 years old, with blunt severe TBI. Exclusion criteria was no recorded race, those without signs of life, had length of stay <1 day and AIS=6 in any body region. Variables included demographic, clinical, and outcome characteristics. The primary outcome was probability of ICP-monitor placement. We calculated incidence rate ratios for ICP monitor placement using a Poisson regression model to adjust for confounders.Results: A total of 260,814 patients were included: 218,939 White, 29,873 Black, 8,322 Asian, 2,884 Native American, and 796 Pacific Islander. Asian and Native American patients had the highest rates of midline shift (16.5% and 16.9%). Pacific Islanders had the highest rates of neurosurgical intervention (19.3%) and ICP monitor placement (6.5%). Asian patients were found to be 19% more likely to receive ICP monitoring [adjusted IRR 1.19 (95%CI: 1.06-1.33), p = 0.003], while Native American patients were 38% less likely [adjusted IRR 0.62 (95%CI: 0.49-0.79), p < 0.001], compared with White patients, respectively. No differences were detected between White and Black patients.Conclusion: ICP monitoring use differs significantly by race. Further work is needed to elucidate modifiable causes of this difference in the management of severe TBI.
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| 3. |
- Zebley, James A., et al.
(författare)
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Racial Disparity in Placement of Intracranial Pressure Monitoring : A TQIP Analysis
- 2023
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Ingår i: Journal of the American College of Surgeons. - : Elsevier. - 1072-7515 .- 1879-1190. ; 236:1, s. 81-92
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Brain Trauma Foundation recommends intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Race is associated with worse outcomes after TBI. The reasons for racial disparities in clinical decision-making around ICP monitor placement remain unclear.STUDY DESIGN: We queried the TQIP database from 2017 to 2019 and included patients 16 years or older, with blunt severe TBI, defined as a head abbreviated injury score 3 or greater. Exclusion criteria were missing race, those without signs of life on admission, length of stay 1 day or less, and AIS of 6 in any body region. The primary outcome was ICP monitor placement, which was calculated using a Poisson regression model with robust SEs while adjusting for confounders.RESULTS: A total of 260,814 patients were included: 218,939 White, 29,873 Black, 8,322 Asian, 2,884 American Indian, and 796 Native Hawaiian or Other Pacific Islander. Asian and American Indian patients had the highest rates of midline shift (16.5% and 16.9%). Native Hawaiian or Other Pacific Islanders had the highest rates of neurosurgical intervention (19.3%) and ICP monitor placement (6.5%). Asian patients were found to be 19% more likely to receive ICP monitoring (adjusted incident rate ratio 1.19; 95% CI 1.06 to 1.33; p = 0.003], and American Indian patients were 38% less likely (adjusted incident rate ratio 0.62; 95% CI 0.49 to 0.79; p < 0.001), compared with White patients, respectively. No differences were detected between White and Black patients.CONCLUSIONS: ICP monitoring use differs by race. Further work is needed to elucidate modifiable causes of this difference in the management of severe TBI.
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