Ethnic and racial disparities in emergency department care for mild traumatic brain injury.
OBJECTIVE
To identify racial, ethnic, and gender disparities in the emergency department (ED) care for mild traumatic brain injury (mTBI).


METHODS
A secondary analysis of ED visits in the National Hospital Ambulatory Medical Care Survey for the years 1998 through 2000 was performed. Cases of mTBI were identified using ICD-9 codes 800.0, 800.5, 850.9, 801.5, 803.0, 803.5, 804.0, 804.5, 850.0, 850.1, 850.5, 850.9, 854.0, and 959.01. ED care variables related to imaging, procedures, treatments, and disposition were analyzed along racial, ethnic, and gender categories. The relationship between race, ethnicity, and selected ED care variables was analyzed using multivariate logistic regression with control for associated injuries, geographic region, and insurance type.


RESULTS
The incidence of mTBI was highest among men (590/100,000), Native Americans/Alaska Natives (1026.2/100,000), and non-Hispanics (391.1/100,000). After controlling for important confounders, Hispanics were more likely than non-Hispanics to receive a nasogastric tube (OR, 6.36; 95% CI = 1.2 to 33.6); nonwhites were more likely to receive ED care by a resident (OR, 3.09; 95% CI = 1.9 to 5.0) and less likely to be sent back to the referring physician after ED discharge (OR, 0.47; 95% CI = 0.3 to 0.9). Men and women received equivalent ED care.


CONCLUSIONS
There are significant racial and ethnic but not gender disparities in ED care for mTBI. The causes of these disparities and the relationship between these disparities and post-mTBI outcome need to be examined.
Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA. jeff_bazarian@urmc.rochester.edu
Jeffrey J
JJ
Bazarian
Charlene
C
Pope
Jason
J
McClung
Yen Ting
YT
Cheng
William
W
Flesher
D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D011287:Prejudice; D044469:Racial Groups