Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

Duong, William; Grigorian, Areg; Farzaneh, Cyrus; Nahmias, Jeffry; Chin, Theresa L.; Schubl, Sebastian; Dolich, Matthew; Lekawa, Michael

doi:10.1177/0003134820960063

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…[25][26][27][28] Previous research has used this approach to evaluate individual state and regional trauma systems. [29][30][31][32][33][34] These observations further align with the work of the Trauma Systems Committee of the American College of Surgeons Committee on Trauma to assess trauma center designation based on population need to ensure timely access to care. 6 As highlighted by the panel, more research is needed to understand the best balance of these priorities (e.g., access, equity, patient volume to care quality relationship) in modern trauma system design.…”

Section: Discussionsupporting

confidence: 53%

Developing a National Trauma Research Action Plan: Results from the trauma systems and informatics panel Delphi survey

Haut¹,

Kirby²,

Bailey³

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND:The National Academies of Sciences, Engineering, and Medicine 2016 report on the trauma care system recommended establishing a National Trauma Research Action Plan to strengthen and guide future trauma research. To address this recommendation, the Department of Defense funded a study to generate a comprehensive research agenda spanning the trauma and burn care continuum. Panels were created to conduct a gap analysis and identify high-priority research questions. The National Trauma Research Action Plan panel reported here addressed trauma systems and informatics. METHODS:Experts were recruited to identify current gaps in trauma systems research, generate research questions, and establish the priorities using an iterative Delphi survey approach from November 2019 through August 2020. Panelists were identified to ensure heterogeneity and generalizability, including military and civilian representation. Panelists were encouraged to use a PICO format to generate research questions: patient/population, intervention, compare/control, and outcome. In subsequent surveys, panelists prioritized each research question on a 9-point Likert scale, categorized as low-, medium-, and high-priority items. Consensus was defined as ≥60% agreement. RESULTS:Twenty-seven subject matter experts generated 570 research questions, of which 427 (75%) achieved the consensus threshold. Of the consensus reaching questions, 209 (49%) were rated high priority, 213 (50%) medium priority, and 5 (1%) low priority. Gaps in understanding the broad array of interventions were identified, including those related to health care infrastructure, technology products, education/training, resuscitation, and operative intervention. The prehospital phase of care was highlighted as an area needing focused research. CONCLUSION:This Delphi gap analysis of trauma systems and informatics research identified high-priority research questions that will help guide investigators and funding agencies in setting research priorities to continue to work toward Zero Preventable Deaths after trauma.

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Section: Discussionsupporting

confidence: 53%

Developing a National Trauma Research Action Plan: Results from the trauma systems and informatics panel Delphi survey

Haut¹,

Kirby²,

Bailey³

et al. 2023

J Trauma Acute Care Surg

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“…Further demonstrating a racial disparity found in major cities, the present study found that not only are Black individuals disproportionately affected by MSEs, but also there are more people injured (eTable 1 in Supplement 1) and more fatalities (eTable 2 in Supplement 1) when the MSEs occur. The reason for these findings could not be examined in this study; however, previous studies have shown that racial disparities exist in the care of injured trauma patients, which may partly explain why the percentage of Black population is associated with increased fatalities in MSEs . Trauma deserts, or urban communities farther than 5 miles away from trauma centers, are also more likely to be communities of color, which may contribute to this disparity .…”

Section: Discussionmentioning

confidence: 78%

Association Between Markers of Structural Racism and Mass Shooting Events in Major US Cities

et al. 2023

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ImportanceThe root cause of mass shooting events (MSEs) and the populations most affected by them are poorly understood.ObjectiveTo examine the association between structural racism and mass shootings in major metropolitan cities in the United States.Design, Setting, and ParticipantsThis cross-sectional study of MSEs in the 51 largest metropolitan statistical areas (MSAs) in the United States analyzes population-based data from 2015 to 2019 and the Gun Violence Archive. The data analysis was performed from February 2021 to January 2022.ExposureShooting event where 4 or more people not including the shooter were injured or killed.Main Outcome and MeasuresMSE incidence and markers of structural racism from demographic data, Gini income coefficient, Black-White segregation index, and violent crime rate.ResultsThere were 865 MSEs across all 51 MSAs from 2015 to 2019 with a total of 3968 injuries and 828 fatalities. Higher segregation index (ρ = 0.46, P = .003) was associated with MSE incidence (adjusted per 100 000 population) using Spearman ρ analysis. Percentage of the MSA population comprising Black individuals (ρ = 0.76, P &lt; .001), children in a single-parent household (ρ = 0.44, P &lt; .001), and violent crime rate (ρ = 0.34, P = .03) were other variables associated with MSEs. On linear regression, structural racism, as measured by percentage of the MSA population comprising Black individuals, was associated with MSEs (β = 0.10; 95% CI, 0.05 to 0.14; P &lt; .001). Segregation index (β = 0.02, 95% CI, −0.03 to 0.06; P = .53), children in a single-parent household (β = −0.04, 95% CI, −0.11 to 0.04; P = .28), and Gini income coefficient (β = −1.02; 95% CI, −11.97 to 9.93; P = .93) were not associated with MSEs on linear regression.Conclusions and RelevanceThis study found that major US cities with higher populations of Black individuals are more likely to be affected by MSEs, suggesting that structural racism may have a role in their incidence. Public health initiatives aiming to prevent MSEs should target factors associated with structural racism to address gun violence.

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“…Our lack of understanding regarding the role SCT plays in multisystem trauma is concerning, given its impact on quality of care for those in Black and Latinx communities 12. If SCT is found to be physiologically linked to multisystem trauma outcomes, then the high prevalence of SCT in communities of color in the USA may intersect with today’s concurrent epidemic of violent trauma, particularly in communities affected by legacies of structural racism, economic marginalization, and worsened by the recent COVID-19 pandemic 16. In light of our scoping literature review’s results and its clinical contexts, we have developed the following calls to action for the trauma surgery community—(1) consider testing for SCT in trauma patients that have unexpected complications, particularly VTE, rhabdomyolysis, or renal failure; (2) support research to understand how SCT impacts multisystem trauma outcomes; and (3) maintain significant caution with causal attribution of SCT to death, especially in cases of grievous bodily injury, given the current lack of medical or surgical literature to support such assertions.…”

Section: Calls To Actionmentioning

confidence: 99%

“…Given US demographics, Black Americans make up the large majority of the nation’s patient population with SCT. Accordingly, in understanding how best to consider and incorporate SCT-positive status into efforts to improve trauma outcomes, it is necessary to also reflect on how the high prevalence of SCT-positive status within Black communities may compound other known drivers of substandard trauma outcomes for Black patients—such as disparities in access to quality care at a structural, institutional, and interpersonal level 16…”

mentioning

confidence: 99%

Sickle cell trait and multisystem trauma: an unaddressed urgent knowledge gap

Tessema

Lapping-Carr

Affini

et al. 2022

Trauma Surg Acute Care Open

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Sickle cell trait (SCT) has historically been considered a benign condition, but SCT-positive patients have increased baseline risk of venous thromboembolism and chronic kidney disease, as well as increased risk of sickled erythrocytes in settings of hypoxia, acidosis, and hypovolemia. Multisystem traumatic injuries are a common clinical scenario, in which hypoxia, acidosis, and hypovolemia occur; however, little is known about how SCT-positive status impacts outcomes in multisystem trauma. We conducted a scoping literature review to investigate what was known about SCT in the setting of multisystem trauma. In the 110+ years that sickle cell hemoglobinopathies have been known, only three studies have ever examined the relationship between SCT and multisystem traumas. All three articles were case reports. None of the articles intentionally measured the association between SCT and multisystem trauma outcomes; they only incidentally captured information on SCT. Our article then examines historical reasons why so little research has studied the pathophysiology of the multisystem trauma in patients with SCT. Among the reasons is that historical and logistical factors have long prevented patients from knowing their SCT-status: historical discriminations against SCT-positive patients in the 1960s and 1970s delayed federal mandating of SCT newborn screening until 2006, whereas difficulties communicating known SCT-status to afflicted children also contributed to lack of patient knowledge. In light of our findings, we offer specific calls to action for the trauma surgery research community: (1) consider testing for SCT in trauma patients that have unexpected complications, particularly venous thromboembolism, rhabdomyolysis, or renal failure and (2) support research to understand how SCT impacts multisystem trauma outcomes. We also offer specific guidelines about how to ‘proceed with caution’ in implementation of these goals in light of the troubled history of SCT testing and policy in the USA.

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Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

Cited by 9 publications

References 23 publications

Developing a National Trauma Research Action Plan: Results from the trauma systems and informatics panel Delphi survey

Developing a National Trauma Research Action Plan: Results from the trauma systems and informatics panel Delphi survey

Association Between Markers of Structural Racism and Mass Shooting Events in Major US Cities

Sickle cell trait and multisystem trauma: an unaddressed urgent knowledge gap

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