title: Does payer status matter in predicting penetrating trauma outcomes?
abstract: BACKGROUND
  Few data exist regarding payer status as a predictor of outcomes in penetrating trauma. This study determined whether insurance status impacts in-hospital complications and mortality in gunshot and stab wound patients at our inner-city, level I trauma center.
  
  
  METHODS
  Penetrating trauma admissions from 2005 to 2009 were reviewed for patient demographics, insurance, Injury Severity Score, complications, duration of stay, and mortality.
  
  
  RESULTS
  A total of 1,347 penetrating trauma patients were admitted with 652 (48.4%) uninsured. Although uninsured patients were more likely to be male (93.3% vs 89.8%, P = .030), there was no difference in age, ISS, or number of radiologic, operative, or interventional procedures. Uninsured patients had lesser intensive care unit (4.4 vs 3.3 days; P = .049) and total hospital length of stay (10.2 vs 8.3; P = .049). No uninsured patients were placed into a rehabilitation facility at the time of discharge (0.0% vs 1.6%, P < .001). There was no difference in frequency of pulmonary complications, thromboembolic complications, sepsis, urinary tract infection, or wound infections. On multivariate analysis, being uninsured was not an independent predictor of in-hospital complications (1.010, 95% confidence interval 0.703-1.450, P = .959) or mortality (odds ratio 0.905, 95% confidence interval 0.523-1.566, P = .722).
  
  
  CONCLUSIONS
  This is the first study to show that penetrating trauma patients who are uninsured have lesser duration of stay and decreased placement into a rehabilitation facility. Being uninsured added no additional risk of in-hospital complications or mortality.
authors: Department of Surgery, Temple University Hospital, Philadelphia, PA, USA. Sharven.Taghavi@tuhs.temple.edu
authors: Sharven
authors: S
authors: Taghavi
authors: Senthil N
authors: SN
authors: Jayarajan
authors: Jason M
authors: JM
authors: Duran
authors: John P
authors: JP
authors: Gaughan
authors: Abhijit
authors: A
authors: Pathak
authors: Thomas A
authors: TA
authors: Santora
authors: Alliric I
authors: AI
authors: Willis
authors: Amy J
authors: AJ
authors: Goldberg
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D014950:Wounds, Penetrating / Q000150:complications / Q000401:mortality*; D055815:Young Adult