Research Reports - Ethnic disparities in traumatic brain injury care referral in a Hispanic-majority population

J Surg Res. 2017 Jul;215:231-238. doi: 10.1016/j.jss.2017.03.062. Epub 2017 Apr
7.

Budnick HC(1), Tyroch AH(2), Milan SA(2).

BACKGROUND: Functional outcomes after traumatic brain injury (TBI) can be
significantly improved by discharge to posthospitalization care facilities. Many
variables influence the discharge disposition of the TBI patient, including
insurance status, patient condition, and patient prognosis. The literature has
demonstrated an ethnic disparity in posthospitalization care referral, with
Hispanics being discharged to rehabilitation and nursing facilities less often
than non-Hispanics. However, this relationship has not been studied in a
Hispanic-majority population, and thus, this study seeks to determine if
differences in neurorehabilitation referrals exist among ethnic groups in a
predominately Hispanic region.
METHODS: This study is a retrospective cohort that includes 1128 TBI patients who
presented to University Medical Center El Paso, Texas, between the years 2005 and
2015. The patients' age, sex, race, residence, admission Glasgow Coma Scale
(GCS), GCS motor, Injury Severity Score (ISS), hospital and intensive care unit
length of stay (LOS), mechanism of injury, and discharge disposition were
analyzed in univariate and multivariate models.
RESULTS: Our study population had an insurance rate of 55.5%. Insurance status
and markers of injury severity (hospital LOS, intensive care unit LOS, ISS, GCS,
and GCS motor) were predictive of discharge disposition to rehabilitation
facilities. The study population was 70% Hispanic, yet Hispanics were discharged
to rehabilitation facilities (relative risk: 0.56, P: 0.001) and to long-term
acute care/nursing facilities (relative risk: 0.35, P < 0.0001) less than
non-Hispanics even after LOS, ISS, ethnicity, insurance status, and residence
were adjusted for in multivariate analysis.
CONCLUSIONS: This study suggests that patients of different ethnicities but
comparable traumatic severity and insurance status receive different discharge
dispositions post-TBI even in regions in which Hispanics are the demographic
majority. 

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