Race Affects Outcomes in Traumatic Arterial Vascular Injury: An Analysis of the National Trauma Data Bank

OBJECTIVES: Racial and ethnic background appears to influence outcomes in patients with vascular disease; however, the effect following arterial injury is unknown. We sought to evaluate the effect of race and ethnicity on outcomes following arterial trauma using a large national database.
METHODS: We queried the National Trauma Data Bank to identify patients aged 18-65 who suffered traumatic arterial injury. Exclusion criteria were declaration of death on arrival, head trauma, burns, and multiple arterial injuries. Demographic information collected included age, race/ethnicity, gender, injury location, severity and mechanism, hospital type and geographic region, and payment source. Outcomes after arterial trauma included interventions performed, intensive care unit (ICU) and hospital lengths of stay (LOS), complication rates, and mortality. Bivariate and multivariate analyses were conducted to assess the effect of race on presentation and outcomes.
RESULTS: Among the 1,309,311 patients in the dataset, we identified 11,868 arterial injuries (mean age 34.4±12.4 years, 82.5% male). The cohort was 47.0% Caucasian, 24.3% African-American, and 14.9% Hispanic. The mean Injury Severity Score was 16.2±13.9. There were significant racial differences in patient age, gender, anatomic location of injury, co-morbidities, geographic region, insurance type, and hospital type. Caucasians were more likely to sustain blunt trauma (62.6%) while African-Americans and Hispanics were more likely to sustain penetrating injury (76.9% and 64.0%) (p<0.001). Caucasian patients had increased hospital LOS compared to African-American and Hispanic patients, (9.34±14.1, 8.61±13.2, and 8.45±13.2 days, respectively. p=.007). Multivariate analysis revealed that African-Americans had higher mortality rates compared with Caucasians for penetrating thoracic (OR=.36, p=0.037) and abdominal (OR=.37, p=0.009) vascular injuries. No significant race effect was noted for blunt vascular injuries.
CONCLUSIONS: Our results demonstrate the presence of a complex relationship between race/ethnicity, demographics, and outcomes in arterial trauma. In penetrating, but not blunt arterial injury, African-American race was associated with higher mortality.