title: Insurance status predicts survival for trauma patients undergoing urgent intervention.
abstract: BACKGROUND
  The purpose of this study was to investigate the relationship between insurance status and outcomes for trauma patients presenting without vital signs undergoing urgent intervention.
  
  
  METHODS
  The National Trauma Data Bank was queried for patients presenting with a systolic blood pressure equal to zero and a Glasgow Coma Scale score of three ("clinically dead"), who underwent urgent thoracotomy and-or laparotomy (UTL). Insured patients were compared with uninsured (INS [-]) patients.
  
  
  RESULTS
  There were 18,171 patients presenting clinically dead having a payment source documented. INS (-) patients were more likely to undergo UTL (5.4% [416-7704] versus 2.7% [285-10,467], 1.481 [1.390-1.577], <0.001). Out of 689 patients who underwent UTL and meeting inclusion criteria, 416 (60.4%) were INS (-). Patients with insurance demonstrated a significantly greater survival (9.9% [27-273] versus 1.7% [7-416], 5.878 [2.596-13.307] P < 0.001). Adjusting for mechanism, race, age, injury severity, and comorbidities, insured status was independently associated with survival.
  
  
  CONCLUSIONS
  The presence of health insurance is independently associated with survival in trauma patients presenting with cardiovascular collapse who undergo urgent surgical intervention.
authors.affiliation: Division of Trauma-Acute Care Surgery and Surgical Critical Care, Department of Surgery, Harbor-UCLA, Medical Center, Torrance, California.
authors.forename: Annie
authors.initials: A
authors.lastname: Falor
authors.affiliation: Division of Trauma-Acute Care Surgery and Surgical Critical Care, Department of Surgery, Harbor-UCLA, Medical Center, Torrance, California.
authors.forename: Dennis
authors.initials: D
authors.lastname: Kim
authors.affiliation: Division of Trauma-Acute Care Surgery and Surgical Critical Care, Department of Surgery, Harbor-UCLA, Medical Center, Torrance, California.
authors.forename: Scott
authors.initials: S
authors.lastname: Bricker
authors.affiliation: Division of Trauma-Acute Care Surgery and Surgical Critical Care, Department of Surgery, Harbor-UCLA, Medical Center, Torrance, California.
authors.forename: Angela
authors.initials: A
authors.lastname: Neville
authors.affiliation: Division of Trauma-Acute Care Surgery and Surgical Critical Care, Department of Surgery, Harbor-UCLA, Medical Center, Torrance, California.
authors.forename: Frederic
authors.initials: F
authors.lastname: Bongard
authors.affiliation: Division of Trauma-Acute Care Surgery and Surgical Critical Care, Department of Surgery, Harbor-UCLA, Medical Center, Torrance, California.
authors.forename: Brant
authors.initials: B
authors.lastname: Putnam
authors.affiliation: Division of Trauma-Acute Care Surgery and Surgical Critical Care, Department of Surgery, Harbor-UCLA, Medical Center, Torrance, California. Electronic address: dsplurad@yahoo.com.
authors.forename: David
authors.initials: D
authors.lastname: Plurad
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000401:mortality*; D012189:Retrospective Studies; D012774:Shock, Traumatic / Q000401:mortality* / Q000601:surgery; D013908:Thoracotomy / Q000401:mortality; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Exploratory laparotomy; Health insurance; In-extremis; Resuscitative thoracotomy; Trauma