Disparities in Access to Care following Traumatic Digit Amputation
Chao Long, AB1; Paola A Suarez, BS1; Tina Hernandez-Boussard, PhD2; Catherine Curtin, MD3; (1)Stanford University, Palo Alto, CA, (2)Department of Surgery, Stanford University, Palo Alto CA, CA, (3)Stanford University Medical Center, Stanford, CA
PURPOSE – Digital amputation is a common cause of emergency room visits. Care of these injuries ranges from revision amputation to replantation. Many factors determine the treatment type including injury type, availability of a hand surgeon and patient preferences. We hypothesized that disparities in care following amputation exist. This study looked at the epidemiology of digit amputation and the factors associated with escalation of care after presenting to the emergency department (ED).
METHODS - We queried the 2006-2009 State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) of the Healthcare Cost and Utilization Project (HCUP), and developed a cohort using the International Classification of Diseases, Ninth Revision (ICD-9) codes for thumb and finger amputation. Escalation of care was defined as patients whose disposition from the ED were either referral to a higher-level hospital or admission as an inpatient. Chi-squared analyses were performed to determine characteristics associated with escalation of care, odds ratios (OR) were calculated to quantify the association, and p<0.05 was considered significant.
RESULTS - Our cohort included 45,586 patients who had finger amputations: 37,539 (82.4%) were male. 7,130 (15.6%) and 38,456 (84.4%) suffered a thumb or finger amputation, respectively. Mean age was 39.3±20.4 years. 7,487 (16.4%) received escalated care. Thumb amputations were associated with a higher likelihood of escalated care than finger amputations (OR 1.9, p<0.05), as were amputations resulting from intentional self-harm (OR 3.8, p<0.05) and patients from a zip code with a median household income in the first or second quartile (OR 1.2, p<0.05). Female sex was associated with less likelihood of escalated care (OR 0.6, p<0.05). Trauma centers of any level were associated with greater escalated care compared to non-trauma hospitals (OR 1.3, p<0.05). Among metropolitan hospitals, those with teaching status were associated with greater escalated care compared to non-teaching hospitals (OR 1.4, p<0.05).
CONCLUSIONS – Male patients who have suffered a thumb and/or self-inflicted amputation, are from a higher income zip code, and present to a teaching trauma center are more likely to receive increased complexity of care. Given the debate about availability of hand surgery emergency care, this study highlights differences in care that can serve as a starting point for future work on barriers and access.
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