Gunshot wounds to the head: racial disparities in inpatient management and outcomes

Chiu, Ryan G.; Fuentes, Angelica M.; Mehta, Ankit I.

doi:10.3171/2019.8.focus19484

Cited by 12 publications

(8 citation statements)

References 17 publications

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“…In considering these factors, this study controlled for patient race/ethnicity as well as insurance status, which in and of itself often serves as a marker of many aspects associated with socioeconomic status in the United States (e.g., lower-income individuals with Medicaid, with comparatively lower access to care, and higherincome individuals with private insurance). 12,13 Thus, by including race/ethnicity and insurance status in our propensity matched final model, we aimed to control for the major aspects of socioeconomic status while taking care not to over-fit the data.…”

Section: Prevalence Psychosocial Factors and The Doctor-patient Relat...mentioning

confidence: 99%

Cannabis Abuse and Perioperative Complications Following Inpatient Spine Surgery in the United States

Chiu

Patel

Siddiqui

et al. 2021

Spine

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Study Design. Retrospective cohort analysis of a nationwide administrative database.Objective. The aim of this study was to analyze the association between cannabis abuse and serious adverse events following elective spine surgery. Summary of Background Data. Cannabis is the most popular illicit drug in the United States, and its use has been increasing in light of state efforts to decriminalize and legalize its use for both medical and recreational purposes. Its legal status has long precluded extensive research into its adverse effects, and to date, little research has been done on the sequelae of cannabis on surgical patients, particularly in spine surgery. Methods. The 2012-2015 Nationwide Inpatient Sample was queried for all patients undergoing common elective spine surgery procedures. These patients were then grouped by the presence of concurrent diagnosis of cannabis use disorder and compared with respect to various peri-and postoperative complications, all-cause mortality, discharge disposition, length of stay, and hospitalization costs. Propensity score matching was utilized to control for potential baseline confounders.Results. A total of 423,978 patients met inclusion/exclusion criteria, 2393 (0.56%) of whom had cannabis use disorder. After controlling for baseline characteristics and comorbid tobacco use, these patients similar inpatient mortality, but higher rates of perioperative thromboembolism (odds ratio [OR] 2.2; 95% confidence interval [CI] 1.2-4.0; P ¼ 0.005), respiratory complications (OR 2.0; 95% CI 1.4 -2.9; P < 0.001), neurologic complications such as stroke and anoxic brain injury (OR 2.9; 95% CI 1.2-7.5; P ¼ 0.007), septicemia/sepsis (OR 1.5; 95% CI 1.0 to 2.5; P ¼ 0.031), and nonroutine discharge (P < 0.001), as well as increased lengths of stay (7.1 vs. 5.2 days, P < 0.001) and hospitalization charges ($137,631.30 vs. $116,112.60, P < 0.001). Conclusion. Cannabis abuse appears to be associated with increased perioperative morbidity among spine surgery patients. Physicians should ensure that a thorough preoperative drug use history is taken, and that affected patients be adequately informed of associated risks.

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Section: Prevalence Psychosocial Factors and The Doctor-patient Relat...mentioning

confidence: 99%

Cannabis Abuse and Perioperative Complications Following Inpatient Spine Surgery in the United States

Chiu

Patel

Siddiqui

et al. 2021

Spine

Self Cite

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“…Chiu et al explored racial disparities in the inpatient management and outcome of 333 GSW to the head victims using the Nationwide Inpatient Sample. 18 They found no significant variation among racial/ethnic groups with respect to mortality, length of hospital stay, or rate of surgical intervention after GSW to the head and conclude that racial disparities may not be as prevalent as previously thought, although age and income status were not studied. Similar to their findings, we did not find that age, race, or socioeconomic status significantly predicted mortality or mRS at discharge in our population.…”

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 96%

Racial and Social Determinants of Civilian Gunshot Wounds to the Head

Rolle

McLellan

Nanda

et al. 2022

The Neurohospitalist

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Objective To assess the clinical, racial, and social characteristics of victims of Gunshot wounds (GSWs) to the head and assess for associations between these factors and outcomes. Summary Background Data Previous literature has not focused on the association of race and socioeconomic factors with these specific injuries. Methods We identified patients with GSWs to the head who presented to 2 urban academic medical centers between 1998 and 2020, and extracted patient-level demographic data, information about the clinical and surgical course, and outcomes at discharge and follow-up. Results The cohort included 250 patients, 90% (n = 226) of whom were male, with a mean age of 28 years. Forty-five percent were white (n = 112), 19% Black (n = 48), 18% Latinx (n = 45), with 6% “other” (n = 16), and 12% “unknown” (n = 29). The majority of patients presented with assault-related trauma (n = 153, 61%) as compared to self-inflicted injuries (n = 97, 39%). Across the entire cohort, sex, age, race, and median income by ZIP code were not significant predictors of outcome. Victims of assault by GSW to the head were more likely to be age 18 or younger (OR 5.26, P = 0.01), between the ages of 19 and 33 years (OR 4.7, P = 0.001), Black (OR 6.66, P < .001), and Latinx (OR 2.65, P = 0.03). Most patients (n = 155, 63%) had a poor functional outcome (modified Rankin Score 3–6) at discharge. Conclusion Age, race, and income status were not independent predictors of mortality or functional outcome at discharge in our population. Assault-related GSWs to the head mostly involved young Black or Latinx men of lower socioeconomic status, while self-inflicted injuries were largely seen in older white men.

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“…Of patients who met the level of care for admittance, White patients were more often discharged to specialized post-acute care, whereas Black and Hispanic patients had a higher prevalence of being discharged home, despite no differences by race/ethnicity in the ISS, length of stay, or disability at discharge. The difference in hospital discharge placement by race has been reported heavily among trauma patients (Asemota et al, 2013; Chiu et al, 2019; Fat et al, 2019). Azin and colleagues emphasize how race plays a significant role in poorer postoperative outcome (Azin et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Violent Penetrating Injuries and Long-Term Adverse Outcomes

Nistler

James

Dugan

et al. 2022

J Interpers Violence

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Violent injury is known to be a chronic, recurrent issue, with high rates of recidivism following initial injury. While the burden of violence is disproportionately felt among young Black men and in communities of color, examination of distinct risk factors and long-term outcomes for other racial and ethnic groups could lead to improved violence intervention strategies. In this study, we examined the risk of violent penetrating injury and long-term adverse outcomes by race and ethnicity. This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a violent penetrating injury between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for the risk of all-cause mortality and violent re-injury at one and 3 years after surviving a penetrating injury. Of the 4191 victims of violent injury, 12% were White, 18% were Hispanic, and the remaining 70% self-identified as Black. Within 3 years after initial injury, Black patients were at the greatest risk of all-cause violent re-injury (vs. Hispanic: HR = 1.46, 95%CI[1.15,1.85], p = 0.002; vs. White: HR = 1.89, 95%CI[1.40,2.57], p < 0.0001), particularly by gunshot wound (vs. Hispanic: HR = 2.04, 95%CI[1.29,3.22] p = 0.002; vs. White: HR = 2.34, 95%CI[1.19,4.60], p = 0.01). At 3-years following initial injury, White patients were at 2.03 times the risk for all-cause mortality, likely due to a 4.96 times greater risk of death by drug or alcohol overdose for White patients compared to Black patients (HR = 4.96, 95%CI[2.25,10.96], p < 0.0001). In conclusion, Black survivors of violent injury have a significantly higher risk of violent re-injury, particularly by gun violence, while White patients are at the highest risk for mortality due to the incidence of drug and alcohol overdose. Violence intervention programs with similar patient populations should explore options to collaborate with drug treatment programs to reach this vulnerable population.

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Gunshot wounds to the head: racial disparities in inpatient management and outcomes

Cited by 12 publications

References 17 publications

Cannabis Abuse and Perioperative Complications Following Inpatient Spine Surgery in the United States

Cannabis Abuse and Perioperative Complications Following Inpatient Spine Surgery in the United States

Racial and Social Determinants of Civilian Gunshot Wounds to the Head

Racial and Ethnic Disparities in Violent Penetrating Injuries and Long-Term Adverse Outcomes

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