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Racial determinants in the posthospitalization management and outcomes for patients with rib fractures
Zachary Stickney, MD, Vitalis Osuji, MD, Jaques Townsend, DO, Kristina Kramer, MD, Reginald Alouidor, MD, Edward Kelly, MD, Yamuna Carey, MD, Tovy Kamine, MD, MBA
University of Massachusetts Chan Baystate, Springfield, MA
Background: Rib fractures are a common traumatic injury and a predictor of increased morbidity and mortality. Post hospitalization management of rib fractures differs by institution, in particular regarding surveillance X-rays and procedures. We investigated the post hospitalization management at a single Level 1 trauma center.
Methods: Rib fracture patients admitted from 11/1/2018 to 10/31/2019 were included. Demographics, outcomes, and results of inpatient and outpatient imaging were collected. Analyzed with X2 test.
Results: 290 patients included (278 white, 12 Black). No significant differences found between Black and white patients' age, gender, ISS, LOS, or initial x-ray pathology. Black patients were less frequently admitted to higher level of care (16.7% vs 47.2%, p=0.029). There were no significant differences in pathology on post hospitalization follow-up X-rays. However, Black patients were significantly more likely to have additional imaging (25.0% v. 4.7%, p=0.003). All patients admitted from clinic or underwent outpatient thoracostomy were white. Black patients were significantly less likely to be alive at 4 years (58.3% vs 81.7%, p=0.045).
Conclusion: Despite small numbers this analysis reveals 3 important disparities in rib fracture care based on race. Black patients are less likely to be admitted to higher level of care, more likely to have repeat imaging rather than procedures or admissions as an outpatient, and less likely to be alive at 4 years. Further work is needed to increase awareness regarding the effects of implicit bias on patient care.
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