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Racial Disparities in Administration of Venous Thromboembolism Prophylaxis After Severe Traumatic Injuries
Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
Örebro University, School of Medical Sciences. Division of Trauma & Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-3583-3443
Örebro University, School of Medical Sciences. Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, US.ORCID iD: 0000-0002-1918-9443
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2023 (English)In: The American surgeon, ISSN 0003-1348, E-ISSN 1555-9823, Vol. 89, no 11, p. 4696-4706Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Race is associated with differences in quality of care process measures and incidence of venous thromboembolism (VTE) in trauma patients. We aimed to investigate if racial disparities exist in the administration of VTE prophylaxis in trauma patients.

METHODS: We queried the Trauma Quality Improvement Project database from 2017 to 2019. Patients ages ≥16 years old with ISS ≥15 were included. Patients with no signs of life on arrival, any AIS ≥6, hospital length of stay <1 day, anticoagulant use before admission, or without recorded race were excluded. Patients were grouped by race: white, black, Asian, American Indian, and Native Hawaiian or Pacific Islander. The association between VTE prophylaxis administration and race was determined using a Poisson regression model with robust standard errors to adjust for confounders.

RESULTS: A total of 285,341 patients were included. Black patients had the highest rates of VTE prophylaxis exposure (73.8%), shortest time to administration (1.6 days), and highest use of low molecular weight heparin (56%). Black patients also had the highest incidence of deep vein thrombosis (2.8%) and pulmonary embolism (1.4%). Black patients were 4% more likely to receive VTE prophylaxis than white patients [adj. IRR (95% CI): 1.04 (1.03-1.05), P < .001]. American Indians were 8% less likely to receive VTE prophylaxis [adj. IRR (95% CI): .92 (.88-.97), P < .001] than white patients. No differences between white and Asian or Native Hawaiian or Pacific Islander patients existed.

DISCUSSION: While black patients had the highest incidence of DVT and PE, they had higher administration rates and earlier initiation of VTE prophylaxis. Further work can elucidate modifiable causes of these differences.

Place, publisher, year, edition, pages
Southeastern Surgical Congress , 2023. Vol. 89, no 11, p. 4696-4706
Keywords [en]
Bias, disparities, prophylaxis, race, trauma, venothromboembolism
National Category
Cardiology and Cardiovascular Disease
Identifiers
URN: urn:nbn:se:oru:diva-101481DOI: 10.1177/00031348221129519ISI: 000859794700001PubMedID: 36151753Scopus ID: 2-s2.0-85139033401OAI: oai:DiVA.org:oru-101481DiVA, id: diva2:1698693
Available from: 2022-09-26 Created: 2022-09-26 Last updated: 2025-02-10Bibliographically approved

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Forssten, Maximilian PeterBass, Gary AlanCao, YangMohseni, Shahin

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