BACKGROUND Research has shown that uninsured patients receive fewer radiographic studies during trauma care, but less is known as to whether differences in care are present among other insurance groups or across different time points during hospitalization. Our objective was to examine the number of radiographic studies administered to a cohort of trauma patients over the entire hospital stay as well as during the first 24-hours of care. METHODS Patient data were obtained from an American College of Surgeons (ACS) verified Level I Trauma Center between January 1, 2011 and December 31, 2012. We used negative binomial regression to construct relative risk (RR) ratios for type and frequency of radiographic imaging received among persons with Medicare, Medicaid, no insurance, or government insurance plans in reference to those with commercial indemnity plans. The analysis was adjusted for patient age, sex, race/ethnicity, injury severity score, injury mechanism, comorbidities, complications, hospital length of stay, and Intensive Care Unit (ICU) admission. RESULTS A total of 3621 records from surviving patients age > =18 years were assessed. After adjustment for potential confounders, the expected number of radiographic studies decreased by 15 % among Medicare recipients (RR 0.85, 95 % CI 0.78-0.93), 11 % among Medicaid recipients (0.89, 0.81-0.99), 10 % among the uninsured (0.90, 0.85-0.96) and 19 % among government insurance groups (0.81, 0.72-0.90), compared with the reference group. This disparity was observed during the first 24-hours of care among patients with Medicare (0.78, 0.71-0.86) and government insurance plans (0.83, 0.74-0.94). Overall, there were no differences in the number of radiographic studies among the uninsured or among Medicaid patients during the first 24-hours of care compared with the reference group, but differences were observed among the uninsured in a sub-analysis of severely injured patients (ISS > 15). CONCLUSIONS Both uninsured and insured patients treated at a not-for-profit verified Level I Trauma Center receive fewer radiographic studies than patients with commercial indemnity plans, even after adjusting for clinical and demographic confounders. There is less disparity in care during the first 24-hours, which suggests that patient pathology is the determining factor for radiographic evaluation during the acute care phase. Results from this study offer initial evidence of disparity in diagnostic imaging across multiple insurance groups over different periods of trauma care.

中文翻译：

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根据患者保险类型，跨多个时间点进行创伤护理期间诊断成像的类型和频率的变化。

背景技术研究表明，没有保险的患者在创伤护理期间接受的放射照相研究较少，但是对于其他保险集团之间还是在住院期间的不同时间点，医疗差异存在的了解较少。我们的目标是检查在整个住院期间以及在护理的头24小时内，对一组创伤患者进行的射线照相研究的数量。方法：从2011年1月1日至2012年12月31日从美国外科医生学院（ACS）验证的I级创伤中心获得患者数据。我们使用负二项式回归来构建放射成像类型和频率的相对危险度（RR）比在拥有Medicare，Medicaid，没有保险的人中间收到的，或具有商业赔偿计划的政府保险计划。该分析针对患者的年龄，性别，种族/民族，损伤严重程度评分，损伤机制，合并症，并发症，住院时间和重症监护病房（ICU）进行了调整。结果评估了≥18岁的存活患者的3621条记录。在对潜在的混杂因素进行调整后，预期的影像学检查数量在Medicare接受者中减少了15％（RR 0.85，95％CI 0.78-0.93），在Medicaid接受者中减少了11％（0.89，0.81-0.99），在未投保的患者中减少了10％（与参考组相比，政府保险组中分别为0.90、0.85-0.96）和19％（0.81、0.72-0.90）。在医疗保险患者的最初24小时内观察到这种差异（0.78，0.71-0。86）和政府保险计划（0.83，0.74-0.94）。总体而言，与参比组相比，在未保险或医疗补助患者在护理的最初24小时内，放射学检查的数量没有差异，但是在对重伤患者进行的亚分析中，未保险的患者之间存在差异（ ISS> 15）。结论在经过非营利性认证的I级创伤中心治疗的未保险患者和已保险患者中，即使在调整了临床和人口统计学混杂因素之后，其放射学检查也少于具有商业弥偿计划的患者。在最初的24小时内，护理方面的差异较小，这表明患者的病理状况是急性护理阶段影像学评估的决定性因素。