Discharges to rehabilitation after bilateral lower extremity fractures - there is no racial disparity.

Abstract

Certain trauma populations require rehabilitation services after inpatient management. However, studies have shown implicit bias against African American patients regarding the access to rehabilitation services. The purpose of this study was to assess the variance in rehabilitation discharges of adult patients who sustained lower extremity bilateral long bone fractures comparing African American and Caucasian patients. The study included African American and Caucasian adult patients who sustained bilateral long bone fractures of the lower extremities. Data was extracted from the National Inpatient Sample (NIS) database of 2019. Demographic information, clinical characteristics, comorbidities, and outcomes for all qualifying patients were compared using propensity score matching analysis. Propensity matching analysis created 361 pairs of patients. The two groups (Caucasian patients and African American patients) had comparable characteristics including age (median years [IQR], 42 [30 - 57] vs. 42 [29 - 58], P = 0.790), sex ([male] 60.7 % vs, 60.7 %), injury severity score (ISS) score (median [IQR], 14 [4 - 26] vs. 14 [5 - 29], P = 0.344) and insurance status (private, 125 (34.6 %) vs. 125 (34.6 %)). The analyses found no significant differences in rehabilitation disposition (199 (56.9 %) vs. 185 (53.8 %), P = 0.460, hospital length of stay (median days [95 % CI], 9 [8, 10] vs. 10 [9, 11], P = 0.116) and overall in-hospital mortality (11 (3.0 %) vs. 17 (4.7 %), P = 0.327) between the groups. Our study identified no significant bias against African American patients who suffered from bilateral long bone fractures of the lower extremities and required rehabilitation services.