Background Previous studies have reported that black race and lack of health insurance coverage are associated with increased mortality following traumatic injury. However the association of race and insurance status with trauma outcomes has not been examined using contemporary, national, population-based data. Methods We used data from the National Inpatient Sample on 215,615 patients admitted to one of 836 hospitals following traumatic injury in 2010. We examined the effects of race and insurance coverage on mortality using two logistic regression models, one for patients aged <65 years and the other for older patients. Results Unadjusted mortality was low for white (2.71%), black (2.54%) and Hispanic (2.03%) patients. We found no difference in adjusted survival for non-elderly black patients compared to white patients (adjusted odds ratio [AOR] 1.04; 95% confidence interval [CI]: 0.90-1.19, P=0.550). Elderly black patients had a 25% lower odds of mortality compared to elderly white patients (AOR 0.75; 95% CI 0.63-0.90; P=0.002). After accounting for survivor bias insurance coverage was not associated with improved survival in younger patients (AOR 0.91; 95% CI: 0.77-1.07; P=0.233). Conclusions Black race is not associated with higher mortality following injury. Health insurance coverage is associated with lower mortality but this may be the result of hospitals’ inability to quickly obtain insurance coverage for uninsured patients who die early in their hospital stay. Increasing insurance coverage may not improve survival for patients hospitalized following injury. Level of Evidence III, Prognostic.

Background: Immunoglobulin E (IgE) blockade with omalizumab has demonstrated clinical benefit in pruritusassociated dermatoses (e.g. atopic dermatitis, bullous pemphigoid, urticaria). In oncology, pruritus-associated cutaneous adverse events (paCAEs) are frequent with immune checkpoint inhibitors (CPIs) and targeted anti-human epidermal growth factor receptor 2 (HER2) therapies. Thus, we sought to evaluate the efficacy and safety of IgE blockade with omalizumab in cancer patients with refractory paCAEs related to CPIs and anti-HER2 agents. Patients and methods: Patients included in this multicenter retrospective analysis received monthly subcutaneous injections of omalizumab for CPI or anti-HER2 therapy-related grade 2/3 pruritus that was refractory to topical corticosteroids plus at least one additional systemic intervention. To assess clinical response to omalizumab, we used the Common Terminology Criteria for Adverse Events version 5.0. The primary endpoint was defined as reduction in the severity of paCAEs to grade 1/0. Results: A total of 34 patients (50% female, median age 67.5 years) received omalizumab for cancer therapy-related paCAEs (71% CPIs; 29% anti-HER2). All had solid tumors (29% breast, 29% genitourinary, 15% lung, 26% other), and most (n ¼ 18, 64%) presented with an urticarial phenotype. In total, 28 of 34 (82%) patients responded to omalizumab. The proportion of patients receiving oral corticosteroids as supportive treatment for management of paCAEs decreased with IgE blockade, from 50% to 9% (P < 0.001). Ten of 32 (31%) patients had interruption of oncologic therapy due to skin toxicity; four of six (67%) were successfully rechallenged following omalizumab. There were no reports of anaphylaxis or hypersensitivity reactions related to omalizumab. Conclusions: IgE blockade with omalizumab demonstrated clinical efficacy and was well tolerated in cancer patients with pruritus related to CPIs and anti-HER2 therapies.

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