title: Racial odds for amputation ratio in traumatic lower extremity fractures.
abstract: BACKGROUND
  Recent studies have demonstrated that black patients receive substandard care compared with white patients across healthcare settings. The purpose of this study was to evaluate the association of race on the management (salvage vs. amputation) of traumatic lower extremity open fractures.
  
  
  METHODS
  Data analysis was conducted using the American College of Surgeon's National Trauma Data Bank. Open tibial and fibular (OTFF) and open femoral (OFF) fractures among adults above the age of 18 were identified by International Classification of Diseases, 9th Revision codes. Injuries were identified as amputated based on the presence of one of three types of knee amputations. Statistical analysis included logistic regression stratified for sex, age, race, mechanism of injury, severity, and insurance type.
  
  
  RESULTS
  From the National Trauma Data Bank, 10,082 OFF and 22,479 OTFF were identified. Amputation rates were 3.1% for OFF and 4.2% for OTFF. With age stratification, the ratio of amputation odds for blacks to amputation odds for whites (i.e., the Racial Odds for Amputation Ratio [ROAR]) demonstrated a significant interaction between black and age in both the OFF (p = 0.028) and OTFF (p = 0.008) groups. In younger patients, a lower ROAR (p = 0.016) favored salvage in blacks, while the ROAR in older patients favored amputation in blacks (p = 0.013). The higher prevalence of penetrating injuries in blacks only accounted for 12.7% of the lower ROAR among younger adults.
  
  
  CONCLUSIONS
  There exists a racial disparity in the management of lower extremity open fractures. Older blacks have greater odds of amputation that is not explained by mechanism. In contrast, younger blacks have lower odds for amputation that is only partially explained by mechanism of injury.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weber
authors.forename: David A
authors.initials: DA
authors.lastname: Shoham
authors.forename: Amy
authors.initials: A
authors.lastname: Luke
authors.forename: R Lawrence
authors.initials: RL
authors.lastname: Reed
authors.forename: Fred A
authors.initials: FA
authors.lastname: Luchette
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000671:Amputation, Surgical / Q000379:methods / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D005264:Femoral Fractures / Q000175:diagnosis / Q000208:ethnology / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods / Q000706:statistics & numerical data; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000208:ethnology / Q000601:surgery*; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis / Q000208:ethnology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D013978:Tibial Fractures / Q000175:diagnosis / Q000208:ethnology / Q000601:surgery; D016896:Treatment Outcome; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult