title: Payer status is associated with the use of prophylactic inferior vena cava filter in high-risk trauma patients.
abstract: BACKGROUND
  It is controversial whether patients at high risk for pulmonary embolism (PE) should receive prophylactic inferior vena cava filters (IVC) filters. This lack of clarity creates the potential for variability and disparities in care. We hypothesized there would be differential use of prophylactic IVC filters for patients at high risk for PE on the basis of insurance status.
  
  
  METHODS
  We performed a retrospective analysis using the National Trauma Databank (2002-2007). We included adult patients at high risk for PE (traumatic brain injury or spinal cord injury) and excluded patients with a diagnosis of deep venous thrombosis (DVT) or PE. Logistic regression was performed to control for confounders and a hierarchical mixed effects model was used to control for center.
  
  
  RESULTS
  A prophylactic filter was placed in 3,331 (4.3%) patients in the study cohort. Patients without insurance had an IVC filter placed less often compared with those with any form of insurance (2.7% vs 4.9%, respectively). After adjusting for confounders, we found that patients without insurance were less likely to receive a prophylactic IVC filter, even when we controlled for center (OR 5.3, P < .001).
  
  
  CONCLUSIONS
  When guidelines lack clarity, unconscious bias has the potential to create a system with different levels of care based on socioeconomic disparities.
authors: Department of Surgery, Stanford University Hospital, Stanford, CA, USA.
authors: Danielle M
authors: DM
authors: Pickham
authors: Rachael A
authors: RA
authors: Callcut
authors: Paul M
authors: PM
authors: Maggio
authors: Matthew W
authors: MW
authors: Mell
authors: David A
authors: DA
authors: Spain
authors: Fritz
authors: F
authors: Bech
authors: Kristan
authors: K
authors: Staudenmayer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D016306:Vena Cava Filters / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000150:complications