Comparative Outcomes for Trauma Patients in Prison and the General Population

Abstract

Background Prisoners are a vulnerable population, and there are few contemporary studies that consider trauma patient outcomes within the prisoner population. Therefore, we sought to provide a descriptive analysis of prisoners involved in trauma and evaluate whether a healthcare disparity exists. We hypothesized that prisoners and non-prisoners have a similar risk of mortality and in-hospital complications after trauma. Methods The Trauma Quality Improvement Program (2015-2016) was queried for trauma patients based upon location inside or outside of prison at the time of injury. A multivariable logistic regression analysis was performed to compare these groups for risk of mortality—the primary outcome. Results From 593,818 trauma patients, 1115 were located in prison. Compared to non-prisoners, prisoner trauma patients had no significant difference in mortality (5.1 vs 6.0%, P = .204). However, after adjusting for covariates, prisoners had a shorter length of stay (LOS) (mean days, 6.3 vs 7.8, P < .001), shorter intensive care unit (ICU) LOS (mean days, 5.44 vs 5.89, P = .004), and fewer complications, including lower rates of drug/alcohol withdrawal (.4% vs 1.1%, P = .030), pneumonia (.5 vs 1.6%, P = .004), and urinary tract infections (.0 vs 1.1%, P < .001). Upon performing a multivariable logistic regression model, prisoner trauma patients had a similar associated risk of mortality compared to non-prisoners (OR 1.61, CI .52-4.94, P = .409). Discussion Our results suggest that prisoner trauma patients at least receive equivalent treatment in terms of mortality and may have better outcomes when considering some complications. Future prospective studies are needed to confirm these results and explore other factors, which impact prisoner patient outcomes.

A Look at Surgical Care in a State Correctional System—Unique and Informative but Incomplete

“…The prison population had similar mortality and morbidity but a slightly shorter length of stay. 4 Before the current report, little had been published about nontrauma surgical care of incarcerated individuals.…”

“…Numerous medical and cultural challenges arise in caring for incarcerated individuals, and academic medical centers have provided much of the medical care for incarcerated persons . Some studies previously attempted to characterize medical and trauma care within penitentiaries. Those studies showed that more than 40% have chronic medical conditions along with higher frequencies of hypertension, obesity, and smoking .…”

“…Those studies showed that more than 40% have chronic medical conditions along with higher frequencies of hypertension, obesity, and smoking . In a retrospective study using the Trauma Quality Improvement Program database, 1115 trauma patients admitted from prison were compared with 592 703 nonprisoners. The prison population had similar mortality and morbidity but a slightly shorter length of stay .…”

Quality of Surgical Care Within the Criminal Justice Health Care System

“…Much of the literature surrounding the correctional health care system is written from the public health perspective and discusses treatment of communicable diseases (eg, HIV or hepatitis C) and access to mental health services, with a notable lack of data on surgical treatments and outcomes . To our knowledge, the largest studies of patients who are incarcerated and treated by a surgical team have focused on trauma and acute care surgery, with studies conducted by the Eastern Association for the Surgery of Trauma and using large trauma databases . While these studies provided important insight, a considerable proportion of surgical patients, such as those who present for less urgent or elective procedures, remains excluded.…”

“…5,6 To our knowledge, the largest studies of patients who are incarcerated and treated by a surgical team have focused on trauma and acute care surgery, with studies conducted by the Eastern Association for the Surgery of Trauma and using large trauma databases. [7][8][9] While these studies provided important insight, a considerable proportion of surgical patients, such as those who present for less urgent or elective procedures, remains excluded. This study sought to evaluate quality outcomes from a broader range of surgical patients and subspecialties by using data from one of the largest correctional hospitals in the US, while also comparing these metrics to institutional and national benchmarks.…”