title: Predictors of mortality, hospital utilization, and the role of race in outcomes in head and neck trauma.
abstract: OBJECTIVE
  A retrospective cross-sectional analysis was undertaken to determine the impact of race and insurance status on trauma outcomes in patients admitted to a Level I trauma center following head and neck fractures.
  
  
  METHODS
  Putative predictive factors, including injury mechanism, hemorrhagic shock, injury severity score (ISS), race, gender, and insurance status, were used in a multivariate outcome analysis to determine their influence on length of hospital stay, number of procedures performed, discharge status, and mortality; P < .05 was significant.
  
  
  RESULTS
  Proportionately more male patients (76.5%) sustained head and neck fractures compared with females (23.5%). Blacks and Hispanics sustained proportionately more gunshot wounds (GSWs) compared with Whites, 16:1 and 7:1, respectively. There were no significant differences in length of hospital stay and mortality based on race or insurance status. Mortality was related to age, GSW as a mechanism of injury, increasing ISS, and shock on admission.
  
  
  CONCLUSIONS
  Minority race and insurance status did not correlate with worse outcomes. Treatment biases in the acutely injured patient with head and neck injuries may be less prevalent than thought, if we consider mortality and utilization of care as primary outcome measures.
authors.affiliation: Former Chief Resident, Department of Oral and Maxillofacial Surgery, Boston Medical Center and Boston University School of Dental Medicine, Boston, MA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Jesin
authors.affiliation: Former Dental Student, Harvard School of Dental Medicine, Boston, MA, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Rashewsky
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Boston Medical Center and Boston University School of Dental Medicine, Boston, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Shapiro
authors.affiliation: Resident, Department of General Surgery, Boston Medical Center, Boston, MA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Tobler
authors.affiliation: Former Chief, Surgical Critical Care at Boston Medical Center, and Associate Professor, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Suresh
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Chief, Trauma Surgery at Boston Medical Center, and Associate Professor, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Burke
authors.affiliation: Residency Director, Department of Oral and Maxillofacial Surgery, Boston Medical Center, and Assistant Professor, Boston University School of Dental Medicine, Boston, MA, USA. Electronic address: Andrew.salama@bmc.org.
authors.forename: Andrew
authors.initials: A
authors.lastname: Salama
mesh_terms: D000328:Adult; D001900:Boston / Q000453:epidemiology; D002574:Cervical Vertebrae / Q000293:injuries*; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D019458:Insurance Coverage; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D012771:Shock, Hemorrhagic / Q000208:ethnology / Q000401:mortality; D012887:Skull Fractures / Q000208:ethnology* / Q000401:mortality*; D016103:Spinal Fractures / Q000208:ethnology* / Q000401:mortality*; D014193:Trauma Centers; D016896:Treatment Outcome