Racial Disparities in Administration of Venous Thromboembolism Prophylaxis After Severe Traumatic Injuries

Authors

James A. Zebley, Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
Jordan M. Estroff, Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
Maximilian Peter Forssten, School of Medical Sciences, Orebro University, Orebro, Sweden.
Gary Alan Bass, School of Medical Sciences, Orebro University, Orebro, Sweden.
Yang Cao, Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden.
Megan T. Quintana, Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
Babak Sarani, Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
Shahin Mohseni, School of Medical Sciences, Orebro University, Orebro, Sweden.

Document Type

Journal Article

Publication Date

11-1-2023

Journal

The American surgeon

Volume

89

Issue

11

DOI

10.1177/00031348221129519

Keywords

bias; disparities; prophylaxis; race; trauma; venothromboembolism

Abstract

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), < .001]. American Indians were 8% less likely to receive VTE prophylaxis [adj. IRR (95% CI): .92 (.88-.97), < .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.

APA Citation

Zebley, James A.; Estroff, Jordan M.; Forssten, Maximilian Peter; Bass, Gary Alan; Cao, Yang; Quintana, Megan T.; Sarani, Babak; and Mohseni, Shahin, "Racial Disparities in Administration of Venous Thromboembolism Prophylaxis After Severe Traumatic Injuries" (2023). GW Authored Works. Paper 3901.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3901

Department

Surgery