90: Uninsured Adult Trauma Patients: Less OR, More Transfers, and Higher Mortality

Abstract

Previous studies on disparities in adult trauma patients have demonstrated increased mortality in uninsured patients compared to insured. Reasons for this disparity remain unclear and may be related to differential location of care after leaving the ED, or potentially from delays in care related to transfers. To determine if there are any differences in transfers from ED to OR, ED to ICU and transfers out of the institution based on insurance status. We utilized the National Trauma DataBank (v.6.2) and extracted the following variables: Insurance type (Uninsured (=self pay, charity), Insured=BCBS); age (19-64); ISS >8; injury type (blunt); systolic BP >0; ED disposition; length of stay; and ICU days. All cases with missing variables excluded. There were 13349 BCBS patients and 55396 uninsured patients analyzed. Although ISS scores in uninsured and BCBS patients were not different (ISS uninsured=16.4, ISS BCBS=16.3, p=0.31), Mortality rates were higher in uninsured (4.9%) compared to BCBS (3.0%) [p<0.001]. Uninsured were twice as likely to be transferred out of the facility (1.6%) compared to BCBS (0.8%) [p<0.001]. Uninsured patients were less likely to go to the OR (16.9%) compared to BCBS (18.5%) p<.0001. Additionally, when taken directly to the OR, uninsured patients were more severely injured (OR ISS scores=19.05) compared to BCBS (OR ISS=17.85) [p<0.0001]. Although ISS scores were slightly lower in uninsured patients going to ICU (ICU ISS=19.62 compared to ICU ISS=20.72 for BCBS (p<0.001)), uninsured ICU patients were more likely to die (ICU uninsured mortality=8.1% compared to BCBS ICU mortality=5.9%, p<.001). Retrospective observational study, data entry errors, past medical history not considered. Although severely injured uninsured and insured adults have similar ISS scores, uninsured are less likely to receive OR care, and uninsured going to the OR were more severely injured (higher ISS) when compared to insured. Uninsured patients in the ICU had lower ISS scores, yet had a substantially higher mortality. These differences may contribute to the disparities in mortality observed between uninsured and insured trauma patients.