Does the Insurance Status Predict the Outcome of the Trauma Patients with Abdominal Gunshot Wounds? Report from a Level I Trauma Academic Center with a Public Hospital

摘要

The uninsured or underinsured patients in the Unites States face a multitude of obstacles in obtaining health care, and there is a concern that they may differ in outcomes from those patients who have insurance. Although lawmakers in the United States have attempted to protect the general public right for receiving emergency care under Emergency Medical Treatment and Labor Act (passed in 1986), the role of payer status and its impact on the patient's outcome in the trauma and acute care setting is less clear. In theory, the standardization of trauma care should reduce disparities in outcome between the underinsured/uninsured and adequately insured. However, previous studies have shown conflicting results. One analysis of the National Trauma Data Bank showed that uninsured patients with penetrating trauma had higher mortality, whereas a single-center study showed no significant increased risk for mortality or morbidity in the uninsured group of patients. The latter study also showed that the uninsured patients had significantly lower duration of hospital stay and decreased placement into a rehabilitation facility.2 In this study, we assessed the impact of insurance status on the length of hospital stay and patients outcome in a predominantly indigent population who presented with abdominal gunshot wounds (AGSWs) to a Level I trauma academic center with a public hospital. This was an Institutional Review Board-approved single-center retrospective analysis at a Level I trauma academic center that serves the entire north Louisiana, east Texas, and south Arkansas area. We retrieved the medical records of adult patients admitted with AGSW between January 2003 and March 2013. To reduce the impact of unknown premorbid conditions on the trauma outcome, patients above the age of 50 were excluded from the study.