Ethnic disparities in initial management of trauma patients in a nationwide sample of emergency department visits

Hypothesis: Ethnic disparities in functional outcomes after traumatic brain injuries have been demonstrated previously. However, it is not clear if these disparities are due to differential access to initial diagnostic and treatment modalities or disproportionate care at poorly funded inner-city emergency departments (EDs). We hypothesized that initial assessment of injured patients in EDs is affected by patient ethnicity. Design: Retrospective database analysis. Setting: Data were obtained from the National Hospital Ambulatory Medical Care Survey ED component for 2003, which includes a national probability sample survey of ED visits. Patients: All injury-related initial ED visits of patients 15 years and older were included. Patients were divided into 3 groups: non-Hispanic white (n = 6106), African American (n = 1406), and Hispanic (n = 1051). Main Outcome Measures: The intensity of ED assessment and management and patient disposition from EDs were compared in the 3 groups. Results: Compared with non-Hispanic white patients, minority patients were slightly younger and less likely to be insured but were similar in sex, mechanism of injury, and injury severity. There were no clinically significant differences between non-Hispanic white patients and the 2 minority groups in ED assessment, diagnostic and treatment modalities, and ED disposition. There were no systematic differences by region of the country, ownership of the hospitals, or insurance status of the patients. Conclusion: The initial assessment and management of injured patients from ethnic/racial minorities was similar to that of non-Hispanic white patients in a nationwide representative sample of ED visits. Other causes of ethnic disparities in outcomes after injuries should be sought.