Disparities Associated with Discharge Patterns in Firearm-Associated Ocular Trauma

Disparities in Rehabilitation Services for Victims of Violence

INTRODUCTION

Access to rehabilitation services after a traumatic injury improves functional outcomes. No study has examined the association between injury intent, violent versus nonviolent, and receipt of rehabilitation services after injury.

MATERIALS AND METHODS

We conducted a retrospective cohort study of injured adult patients admitted to our level I trauma center from January 1, 2014 to December 31, 2021. The primary exposure was violent injury, and the primary outcome was receipt of rehabilitation services upon discharge. An exploratory subgroup analysis evaluated differences in recommended disposition and the reasons for rejection from services.

RESULTS

Among 7500 patients, 1677 (22.4%) were violently injured and 5823 (77.6%) were nonviolently injured. Patients were 45% White, 67% male, and 52% had public insurance. Adjusting for age, sex, race, ethnicity, injury severity score, insurance, and length of stay, violently injured patients were 77% less likely to receive inpatient rehabilitation (relative risk ratio 0.23 95% confidence interval [0.18, 0.30], P < 0.001) and 46% less likely to have home services (relative risk ratio 0.54, 95% confidence interval[0.43, 0.69], P < 0.001). A subgroup analysis (n = 328) demonstrated that violently injured patients were more likely to have a downgrade in discharge recommendation (27.8% versus 9.4%, P = 0.04) and more likely to have an emergency department visit within 30 d (32.0% versus 13.3%, P < 0.001).

CONCLUSIONS

Violent injury is associated with lower likelihood of receiving rehabilitation services. Subgroup analysis indicates this finding associated with facilities' selection bias, and this warrants additional study. Efforts should focus on protecting victims of violence from discrimination during the rehabilitation screening process.

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

BACKGROUND

Few ocular trauma studies have addressed mortality outcomes. We sought to determine characteristics of mortality-related ocular trauma admissions and compared them with non-fatal injuries.

METHODS

A retrospective study was conducted using de-identified data of patients admitted with major trauma from the National Trauma Data Bank (2008-2014). Patients with ocular injury were identified using ICD- 9CM codes. Demographics, intention and mechanism, types of ocular and head injuries, and injury severity were documented. Mortality was determined using post-admission disposition. Statistical analysis using student t-test, chi-square, and odds ratios (OR) calculations were performed with STATA-17 software. Significance was set at P < 0.05.

RESULTS

Of 316,485 patients admitted with ocular trauma, 12,233 (3.86%) were mortality related. Expired patients were older than survivors: mean (SD) of 50.1(25.5) vs. 41.5(22.8) years. White (OR = 1.32; P < 0.001), ≥ 65years old (OR = 2.25; P < 0.001), and male (OR = 1.05; P = 0.029) patients were most likely to expire than their counterparts. Common mechanisms of injury in survivors were falls (25.3%), motor vehicle traffic-occupant, MVTO (21.8%) and struck by/against (18.1%) and for fatal injuries, falls (29.7%), MVTO (21.9%) and firearms (11.5%). Traumatic brain injury (TBI) was documented in 88.2% of mortality-related admissions. Very severe injury severity scores (ISS > 24) (OR = 19.19; P < 0.001) and severe Glasgow Coma Score (GCS < 8) (OR = 19.22; P < 0.001) were most associated with mortality than survival. Firearms were most associated with very severe ISS (OR = 3.73; P < 0.001), severe GCS (OR = 4.68; P < 0.001) and mortality (OR = 5.21; P < 0.001) than other mechanisms. Patients with cut/pierce injuries had the greatest odds of survival (OR = 13.48; P < 0.001). Optic nerve/visual pathways injuries (3.1%) had the highest association with very severe ISS (OR = 2.51; P < 0.001), severe GCS (OR = 3.64; P < 0.001) and mortality (OR = 2.58; P < 0.001) than other ocular injuries. Black patients with very severe ISS (OR = 32.14; P < 0.001) and severe GCS (OR = 31.89; P < 0.001) were more likely to expire than other race/ethnicities with similar injury severity.

CONCLUSIONS

Mortality-related admissions were older, male, and mostly of White race than ocular trauma admissions of survivors. Firearms were the deadliest mechanism. TBI was commonly associated and patients with optic nerve/pathway injuries, very severe ISS and severe GCS had higher mortality rates. Characteristics and demographic variations identified in this study may be useful in developing focused measures aimed at preventing trauma-related deaths.