Area Deprivation Index Score Is Associated With Lower Rates of Long-Term Follow-up After Upper Extremity Vascular Injuries

Abstract

The Area Deprivation Index (ADI) has recently been shown to be a key determinant of several health care outcomes in both medical and surgical fields. We sought to analyze rates of long-term follow-up and outcomes in patients with upper extremity vascular injuries who were admitted during a 5-year period to a level I trauma center based in a university hospital setting. The patients were divided into two groups based on their ADI, with the first group representing the lowest quartile of patients and the second group the higher three quartiles. Patients’ demographics as well as modes of trauma, hospital transfer status before receiving care, type of intervention received, follow-up rates, and outcomes including both complication and amputation rates were analyzed. Between January 2013 and December 2017, a total of 88 patients with traumatic upper extremity vascular injuries were identified. The majority of injuries were due to penetrating trauma (74/88 [84%]), with 41% (10/24) of patients in the lower ADI being victims of gunshot wounds compared with 27% (17/64) of those in the higher ADI (P = .19). Patients in the lowest ADI quartile were more likely to be African Americans (P = .0001) and more likely to be transferred to our university hospital before receiving care (P = .007). Arrival Glasgow Coma Scale score and Injury Severity Score were similar, as was time spent in the emergency department. Length of stay trended longer in the lowest ADI quartile compared with the higher ADI (7.5 vs 11.8; P = .59). The rates of long-term follow-up were significantly lower in patients with the lowest ADI scores as opposed to the higher ADI (P = .0098); however, there was no statistically significant difference in outcomes between the two groups, including both complication and amputation rates. The ADI is associated with lower rates of long-term follow-up after upper extremity vascular injuries despite patients’ having similar outcomes in regard to complication and amputation rates in both the high and low ADI groups. Further study is warranted to investigate the role of the socioeconomic status in outcomes after traumatic injury.