title: Insurance status is a potent predictor of outcomes in both blunt and penetrating trauma.
abstract: BACKGROUND
  Patients with penetrating injuries are known to have worse outcomes than those with blunt trauma. We hypothesize that within each injury mechanism there should be no outcome difference between insured and uninsured patients.
  
  
  METHODS
  The National Trauma Data Bank version 7 was analyzed. Patients aged 65 years and older and burn patients were excluded. The insurance status was categorized as insured (private, government/military, or Medicaid) and uninsured. Multivariate analysis adjusted for insurance status, mechanism of injury, age, race, sex, injury severity score, shock, head injury, extremity injury, teaching hospital status, and year.
  
  
  RESULTS
  A total of 1,203,243 patients were analyzed, with a mortality rate of 3.7%. The death rate was significantly higher in penetrating trauma patients versus blunt trauma patients (7.9% vs 3.0%; P < .001), and higher in the uninsured (5.3% vs 3.2%; P < .001). On multivariate analysis, uninsured patients had an increased odds of death than insured patients, in both penetrating and blunt trauma patients. Penetrating trauma patients with insurance still had a greater risk of death than blunt trauma patients without insurance.
  
  
  CONCLUSIONS
  Insurance status is a potent predictor of outcome in both penetrating and blunt trauma.
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC, USA. wgreene@howard.edu
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Greene
authors.forename: Tolulope A
authors.initials: TA
authors.lastname: Oyetunji
authors.forename: Umar
authors.initials: U
authors.lastname: Bowers
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Mellman
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: Suryanarayana M
authors.initials: SM
authors.lastname: Siram
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000191:economics / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D019458:Insurance Coverage; D007348:Insurance, Health; D007902:Length of Stay; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D014949:Wounds, Nonpenetrating / Q000191:economics* / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D014950:Wounds, Penetrating / Q000191:economics* / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D055815:Young Adult