Disparities Associated with Discharge Patterns in Firearm-Associated Ocular Trauma

Abstract

ImportanceFirearm injuries are associated with devastating visual outcomes. Several studies have demonstrated disparities in trauma care and discharge to rehabilitation and other advanced care facilities (ACFs) due to race and ethnicity and insurance status. The identification of possible disparities in disposition of patients admitted with firearms-associated ocular injuries (FAOIs) is a crucial step in moving toward health equity.ObjectiveTo describe disposition patterns following admission for FAOI trauma.Design, Setting, and ParticipantsThis retrospective analysis of National Trauma Data Bank (NTDB) from 2008 through 2014 used hospitalized trauma cases from over 900 US facilities detailed in the NTDB. Participants included patients admitted with ocular injuries. Statistical analysis was conducted between April 16, 2017, and December 15, 2021.ExposureFirearm injuries.Main Outcomes and MeasuresPatients admitted with FAOIs were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes and E-codes. Demographic data, location, injury type and severity, and insurance status were documented. The primary outcome was the odds of discharge to ACFs.ResultsA total of 8715 of 235 254 firearms injuries involved the eye (3.7%). Of the 8715 included patients, 7469 were male (85.7%), 3050 were African American (35.0%), and 4065 White (46.6%), with a mean (SD) age of 33.8 (16.9) years. Common payments were government insurance (31.5%), self-paid insurance (29.4%), and commercial insurance plans (22.8%). Frequent dispositions were home (48.8%) and ACF (20.5%). Multivariate analysis demonstrated that the following factors were associated with the highest odds of discharge to an ACF: hospital stays 6 days or longer (odds ratio [OR], 3.05; 95% CI, 2.56-3.63; P < .001), age 65 years or older (OR, 2.94; 95% CI, 1.94-4.48; P < .001), associated traumatic brain injury (OR, 2.32; 95% CI, 1.94-2.78; P < .001), severe traumatic brain injury (OR, 2.10; 95% CI, 1.79-2.46; P < .001), and very severe Injury Severity Score (OR, 2.22; 95% CI, 1.88-2.62; P < .001). White race (OR, 2.00; 95% CI, 1.71-2.33; P < .001) was associated with higher odds than Medicare insurance (OR, 1.64; 95% CI, 1.16-2.31; P = .01).Conclusions and RelevanceThese findings suggest that older, more severely injured, Medicare-insured, or White patients have higher odds of ACF placement than younger, less severely injured, otherwise insured, and Black and Hispanic patients. This study is limited by its retrospective nature and the study team was unable to explore the basis for these disposition differences. Nevertheless, this work highlights that disparities may exist in disposition after FAOIs that may limit the rehabilitation potential of specific populations.

Characteristics of ocular injuries associated with mortality in patients admitted with major trauma

“…Black and Hispanic patients were less likely to be allocated to advanced care facility than their White counterparts. This was noted for all insurance coverage and injury severity levels [ 55 ]. Further research that illuminates specific factors associated with increased mortality of minority patients admitted with very severe injury is warranted.…”

Challenges Assessing Disparities in Patients Discharged After Firearm-Associated Ocular Injury

“…In the field of ocular trauma, disparities in discharge patterns and visual outcomes have been reported in research. [1][2][3] A prior study 2 investigating older patients with ocular trauma found that Black, Hispanic, male, and self-paying patients were disproportionately discharged home. Knowing that ocular trauma due to gunshot wounds can lead to longterm visual damage outcomes, 3 in-depth analyses of patient discharge patterns after firearm-associated ocular injury (FAOI) can elucidate underlying disparities in care.A recent study in this issue of JAMA Ophthalmology by Mike et al 1 reports disparities in discharges to an advanced care facility (ACF) after being admitted with FAOI in the US.…”