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

Charles D. Mabry, MD1
[+] Author Affiliations
1Department of Surgery, University of Arkansas for Medical Sciences, Little Rock
JAMA Surg. Published online February 19, 2014. doi:10.1001/jamasurg.2013.4403
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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.

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