We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

Does a “Wallet Biopsy” Lead to Inappropriate Trauma Patient Care?

Charles D. Mabry, MD1
[+] Author Affiliations
1Department of Surgery, University of Arkansas for Medical Sciences, Little Rock
JAMA Surg. 2014;149(5):430-431. doi:10.1001/jamasurg.2013.4403.
Text Size: A A A
Published online


Delgado et al1 have attempted to answer a persistent question in the world of trauma: does the financial status of a trauma patient influence the pattern of care delivered? They used a large national database of emergency department (ED) encounters, and a prodigious amount of statistical firepower, to examine data on roughly 4500 patients with significant trauma who were initially seen in a non–trauma center hospital and then either admitted or transferred out to another hospital. They found that patients with Medicaid and patients with private insurance were 14.3% and 11.2%, respectively, more likely (or “at risk”) to be admitted at the local hospital than patients without insurance. Their findings tend to reinforce a common notion in the trauma community that the financial status (known commonly as a “wallet biopsy”) of a patient influences how and where trauma patients are treated. Let’s be clear: there is no question that trauma systems and trauma centers have been shown to be beneficial to patients by reducing complications and death. I am a great believer in trauma centers and trauma systems. Therefore, if patients are being denied appropriate care because of financial factors, this indeed is a serious matter. However, before we embrace the authors’ conclusions as absolute fact, let’s ask a series of questions.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
Clarifying Your Question

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
Three Examples of Question Clarification