Racial Distribution and Associated Outcomes for Patients With and Without Severe-Isolated Traumatic Brain Injuries Following Venous Thromboembolism Prophylaxis

Abstract

Introduction

Disparities in venous thromboembolism (VTE) incidence and prophylaxis have been observed across racial groups. This study investigates the relationship between race, injury type, and the timing of VTE prophylaxis in severe trauma patients, both with and without isolated traumatic brain injuries. The primary goal is to analyze how these factors interact and their potential impact on clinical outcomes.

Methods

A retrospective cohort study of the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) from 2018 to 2021. Patient demographics, injury categories, VTE prophylaxis timing, injury severity, and in-hospital complications were collected. Multivariable regression models explored associations between race, injury type, VTE prophylaxis, and in-hospital mortality. Groups were analyzed by injury profile (isolated TBI vs non-TBI) and then by VTE prophylaxis timing (early ≤24 hours, late >24 hours).

Results

Of 68,504 trauma patients analyzed, the majority were non-Hispanic or Latino (83.3%), White (71.2%), and male (69.6%). Patients receiving late VTE prophylaxis had higher rates of DVT and PE across race groups than patients with early prophylaxis. Logistic regression showed Asian patients with TBI receiving early prophylaxis were significantly more likely to have in-hospital mortality (OR 16.27, CI = 1.11-237.43, P = .04) than other races.

Conclusion

Patients who received late prophylaxis had higher VTE rates than early prophylaxis, independent of injury pattern or race. Additionally, assessing the implications of race in early VTE prophylaxis for isolated TBI showed that adult Asian patients had 16 times higher odds of in-hospital mortality compared to other races.

Keywords

venous thromboembolism traumatic brain injuries early prophylaxis racial disparities

Introduction

Venous thromboembolism (VTE), which includes conditions like deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a significant health risk to patients recovering from traumatic injuries.¹ Despite established protocols for VTE prevention, there are documented racial disparities in the incidence of VTE, with some racial groups, particularly Black patients, experiencing higher rates compared to others.² While studies have investigated racial disparities in VTE prophylaxis and its timing, there is still limited literature specifically addressing the impact of race on VTE prophylaxis timing, specifically in patients with traumatic brain injury. 3

A previous study by Liasidis et al (2022) found an increased incidence of VTE, DVT, and PE, specifically among Black patients with isolated severe pelvic fractures compared to White patients. ⁴ Similarly, Zebley et al found Black trauma patients to have the highest incidence of VTE amongst racial groups despite also being 4% more likely to receive VTE prophylaxis than white patients and having the shortest time to administration.³ American Indian patients in this study were also 8% less likely to receive VTE prophylaxis.³ Despite these findings, there remains a lack of literature exploring these racial differences, specifically in patients with traumatic brain injury. Much also remains to be determined about the etiology of these differences.

As such, a comprehensive investigation is necessary to better understand the etiology of racial differences in VTE prophylaxis outcomes and the incidence of this difference in patients with traumatic brain injury. This study explores the complex interactions between race, injury type, and the timing of VTE prophylaxis in patients with and without traumatic brain injury. By doing so, this research seeks to shed light on the factors influencing clinical outcomes and ultimately contribute to the development of tailored interventions that promote equitable VTE prophylaxis outcomes across all racial cohorts.

Methods

Study Design

This is a retrospective cohort study of the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) 2018-2021 limited, de-identified dataset.⁵ The database was retrospectively reviewed to collect demographics (age, sex, race, ethnicity, insurance, and mode of transportation), injury categories and characteristics (systolic blood pressure [SBP] to calculate hypotension, venous thromboembolism [VTE] prophylaxis type and timing, injury severity score [ISS], abbreviated injury scale [AIS] scores, Glasgow Coma Scale [GCS], trauma type [ICD10]), in-hospital complications (pulmonary embolism [PE], deep vein thromboembolism [DVT]), and in-hospital mortality.

Study Inclusion Criteria and Study Population Characteristics

The inclusion criteria were based on adult (≥16 years) trauma patients admitted to trauma centers in the United States who participate in the American College of Surgeons National Trauma Quality Improvement Program.⁶ Patients were excluded if they experienced emergency department (ED) mortality, had an ISS ≤9, did not receive any VTE prophylaxis, or had a penetrating trauma type (Figure 1). The data were stratified into 2 groups, those with a severe isolated traumatic brain injury (TBI) (ie, isolated TBI) or a severe isolated non-TBI group (ie, isolated non-TBI). The isolate TBI group was defined as having an AIS head injury score of ≥3 with all other body regions ≤2 and were diagnosed with either subarachnoid, intracerebral, subdural, epidural, and/or intraventricular hemorrhage by AIS coding (Supplementary e-Table 1). Patients were excluded from the isolated TBI group if they had a GCS >8. The isolated non-TBI comparative group was defined as having an AIS head injury score ≤2 and other body region AIS score ≥3. Patients were excluded from the comparative group if they had an ISS <25. The ACS-TQIP-PUF research data file represents research data from across 796 U.S. trauma centers Level I, II, III, IV, V, or undesignated and contains all records sent to the National Trauma Data Bank (NTDB).⁵

Data Analysis

Descriptive statistics, including mean (standard deviation), median (interquartile range), and frequencies (percentage), were reported for the full sample. The data were initially stratified into 2 groups, severe isolated TBI and severe isolated non-TBI, to describe differences in patient demographics, injury categories, and in-hospital complications based on the timing of VTE prophylaxis. Early VTE prophylaxis is defined as the administration of prophylaxis given ≤24 hours. Continuous variables were compared using the Kruskal-Wallis test, whereas categorical variables were compared using Pearson’s Chi-square test or Fisher's Exact test of proportions, as appropriate in R software.

A multivariable regression analysis was performed on the sample population. The predictor variables for the regression model were chosen using a multicollinearity test for tolerance with values above .5, which satisfied the goodness of fit. All variables selected for the model were independent of one another. For all models, P-values less than .05 were considered statistically significant. The dependent variables for the logistic regression analysis were isolated TBI early VTE prophylaxis, isolated TBI late VTE prophylaxis, isolated non-TBI late VTE prophylaxis, and isolated non-TBI late VTE prophylaxis. Racial disparities and distribution effects evaluated in this model included primarily the following races: Black, Asian, Pacific Islander, White, and American Indian. The covariates that were used to control the model included (age, gender, ethnicity, race, insurance provider, mode of transportation), injury categories (hypotension [SBP <90] and VTE prophylaxis type [LMWH, unfractionated heparin, other]). The data were analyzed using a multivariable logistic regression in SPSS-28 [Armonk, NY). This research was determined to be exempt from the Marshfield Clinic Research Institute [IRB-23-1167] Institutional Review Board oversight in accordance with current regulations.

Results

Population Demographics

A total of 68,504 patients were included in the analysis; 4123 (6.0%) had a confirmed isolated TBI (Table 1A). The average age of the sample population was 46.8 years [SD = 19.8] and were majority non-Hispanic or Latino (n = 57,129; 83.3%), White (n = 48,796; 71.2%), and male (n = 47,693; 69.6%). The majority of patients were administered LMWH (n = 49,727; 72%).

Table 1A.

Descriptive Statistics of the Patient Demographics, Kruskal-Wallis, Chi-Square Tests Among Adults (≥16 years) Who Did Not Expire in the ED With Moderate to Severe Blunt Injures (ISS ≥9) that Were Administered VTE Prophylaxis (N = 68,504).

	Total (N = 68504)	Severe Isolated TBI (N = 4123; 6.0%)		Severe Isolated Body Injury (N = 64,381; 93.9%)		P-value
	Total (N = 68504)	TBI group early VTE PPX (N = 107; .1%)	TBI late VTE PPX (N = 4016; 5.8%)	Body early VTE PPX (N = 5992; 8.7%)	Body late VTE PPX (N = 58,389; 85.2%)	P-value
Age (N = 68504; 100% $\bar{X}$ , M [SD] IQR)	46.8, 45 [19.8] 34	50.1, 50 [21.2] 37.5	46.8, 45 [19.8] 33	43.9, 41 [18.7] 31	47.2, 46 [19.9] 34	<.01
Sex						<.01
Female (N; %)	20580; 30.0%	25; 23.3%	846; 21.0%	1776; 29.6%	17933; 30.7%
Male (N; %)	47693; 69.6%	82; 76.6%	3155; 78.5%	4204; 70.1%	40252; 68.9%
Non-binary (N; %)	9; .01%				9; .01%
Race						<.01
African American (N; %)	9799; 14.3%	12; 11.2%	473; 11.7%	1075; 17.9%	8239; 14.1%
Indian American (N; %)	635; .9%	2; 1.8%	55; 1.3%	36; .6%	542; .9%
Asian (N; %)	1638; 2.3%	4; 3.7%	145; 3.6%	95; 1.5%	1394; 2.3%
Caucasian (N; %)	48796; 71.2%	73; 68.2%	2759; 68.7%	4151; 69.2%	41813; 71.6%
Pacific Islander (N; %)	204; .2%		15; .3%	7; .1%	182; .3%
Other (n = 5638) unknown (n = 1384) NA (n = 410) (N; %)	7432; 10.8%	16; 14.9%	569; 14.1%	628; 10.4%	6219; 10.6%
Ethnicity						<.01
Hispanic or Latino (N; %)	8544; 12.4%	14; 13.0%	628; 15.6%	708; 11.8%	7194; 12.3%
Not Hispanic or Latino (N; %)	57129; 83.3%	84; 78.5%	3189; 79.4%	5052; 84.3%	48804; 83.5%
Insurance						<.01
Medicaid (N; %)	12621; 18.4%	16; 14.9%	912; 22.7%	1076; 17.9%	10617; 18.1%
Medicare (N; %)	12419; 18.1%	30; 28.0%	856; 21.3%	840; 14.0%	10693; 18.3%
Private/Commercial (N; %)	30413; 44.3%	34; 31.7%	1433; 35.6%	2723; 45.4%	26223; 44.9%
Self-pay (N; %)	7157; 10.4%	21; 19.6%	431; 10.7%	787; 13.1%	5918; 10.1%
Other (n = 2347), other government (n = 1856), not billed (n = 167) (N; %)	4370; 6.3%	4; 3.7%	280; 6.9%	423; 7.0%	3663; 6.2%
Mode of Transportation						<.01
Ground ambulance (N; %)	48121; 70.2%	72; 67.2%	2621; 65.2%	4288; 71.5%	41140; 70.4%
Fixed-wing ambulance (N; %)	600; .8%	3; 2.8%	48; 1.1%	66; 1.1%	483; .8%
Helicopter ambulance (N; %)	18117; 26.4%	29; 27.1%	1275; 31.7%	1446; 24.1%	15367; 26.3%
Private/Public vehicle (N; %)	932; 1.3%	2; 1.8%	30; .7%	114; 1.9%	786; 1.3%
Other (n = 468), police (n = 41) (N; %)	509; .7%		33; .8%	53; .8%	423; .7%

Isolated TBI Early VTE Prophylaxis

A total of 107 of the sample population had isolated TBI with early VTE prophylaxis administration (Table 1A). This sub-group was significantly older, with a mean age of 50 years (SD = 21.2; P < .01). The TBI early VTE prophylaxis groups had significantly more patients paying through Medicare (28.0%) insurance coverage and self-pay (19.6%) and traveled to the trauma center by fixed-wing ambulance (2.8%; all values P < .01). This group was most likely to have received UFH as a VTE prophylaxis (53.2%; P < .01; Table 1B).

Table 1B.

Descriptive Statistics of the Injury Characteristics, Chi-Square Among Adults (≥16 years) Who Did Not Expire in the ED With Moderate to Severe Blunt Injures (ISS ≥9) that Were Administered VTE Prophylaxis (N = 68,504).

	Total (N = 68504)	Severe Isolated TBI (N = 4123; 6.0%)		Severe Isolated Body Injury (N = 64,381; 93.9%)		P-value
	Total (N = 68504)	TBI group early VTE PPX (N = 107; .1%)	TBI late VTE PPX (N = 4016; 5.8%)	Body early VTE PPX (N = 5992; 8.7%)	Body late VTE PPX (N = 58,389; 85.2%)	P-value
Hypotensive (yes) (N; %)	7435; 10.8%	6; 5.6%	74; 1.8%	580; 9.6%	6775; 11.6%	<.01
VTE Prophylaxis Type						<.01
Low molecular weight heparin (N; %)	49727; 72%	35; 32.7%	2329; 57.9%	3905; 65.1%	43458; 74.4%
Unfractionated heparin (N; %)	17566; 25.6%	57; 53.2%	1639; 40.8%	1925; 32.1%	13945; 23.8%
Other (n = 820), coumadin (n = 18), xa inhibitor (n = 271), direct thrombin inhibitor (n = 96) (N; %)	1205; 1.7%	15, 14.0%	47; 1.1%	162; 2.7%	981; 1.6%

Isolated TBI Late VTE Prophylaxis

A total of 4016 (5.8%) patients were observed to have isolated TBI with late VTE prophylaxis administration (Table 1A). This patient sub-group was most likely Hispanic or Latino (15.6%), a majority had private/commercial insurance (35.6%), traveled to the trauma center by helicopter ambulance (31.7%), and were most likely to receive an LMWH (57.9%; all values P < .01).

Severe Isolated Non-TBI Early VTE Prophylaxis

A total of 5992 (8.7%) of the sample population were observed to have isolated non-TBI with early VTE prophylaxis (Table 1A). On average, this population was younger (mean age = 43.9 years; SD = 18.7), and the majority were White/Caucasian, (69.2%), however, Black/African American patients were more proportionately to receive early VTE PPx compared to other patients’ population within this group apart from White patients (17.9% Black vs 69.2% White). Additionally, the majority of this group had private or commercial insurance (45.4%) and traveled by ground ambulance (71.5%; P < .01; Table 1A). This group was most likely to have received LMWH as a VTE prophylaxis (65.1%; P < .01; Table 1B).

Severe Isolated Non-TBI Group Late VTE Prophylaxis

A total of 58,389 (85.2%) of the study population were observed to have isolated non-TBI with late VTE prophylaxis (Table 1A). This population was more likely to be White (71.6%), hypotensive (11.6%), and female (30.7%; all values P < .01). This sub-group had the highest proportion of LMWH (74.4%; P < .01) VTE prophylaxis administration compared to the other 3 groups (Table 1B).

Outcomes

Complications

A total of 2806 (4.6%) patients were found to have a DVT, and 1447 (2.1%) were found to have a PE. For DVT, most patients were White (70.1%), with Black (15.4%) and Asian (1.7%) populations being the next largest racial groups. Similarly, for PE, most patients were White (67.8%), with Black (17.3%) and Asian (1.8%) populations being the next largest racial groups. Across all racial categories, patients receiving late VTE prophylaxis in both the isolated TBI and non-TBI groups were consistently found to have higher rates of both DVT and PE compared to patients receiving early VTE prophylaxis (Table 2). Notably, for isolated TBI patients receiving early VTE prophylaxis, the occurrence was very low across all racial groups, with only 2 patients having DVT and 2 patients having PE. In contrast, non-TBI patients who received late VTE prophylaxis had the highest occurrence across all groups.

Table 2.

Descriptive Statistics Among Adults (≥16 years) Who Did Not Expire in the ED With Moderate to Severe Blunt Injures (ISS ≥9) that Were Administered VTE Prophylaxis (N = 68,504).

	Total	DVT (2086; 4.1%)					PE (1447; 2.1%)
	Total	Black (489, 15.4%)	American Indian (21, .6%)	Asian (57, 1.7%)	White (2226, 70.1%)	Pacific Islander (13, .4%)	Black (287, 17.3%)	American Indian (6, .3%)	Asian (31, 1.8%)	White (1121, 67.8%)	Pacific Islander (2, .1%)
Isolated TBI Early VTE Prophylaxis (N, (%))	107, [.1%]	1, [.2%]	0, [0%]	0, [0%]	1, [.04%]	0, [0%]	1, [.3%]	0, [0%]	0, [0%]	1, [.08%]	0, [0%]
Isolated TBI Late VTE Prophylaxis (N, (%))	4016, [5.8%]	23, [4.7%]	1, [4.7%]	3, [5.2%]	118, [5.3%]	0, [0%]	7, [2.4%]	0, [0%]	3, [9.6%]	36, [3.2%]	0, [0%]
Isolated Non-TBI Early VTE Prophylaxis (N, (%))	5992, [8.7%]	42, [8.5%]	1, [4.7%]	1, [1.7%]	127, [5.7%]	0, [0%]	22 [7.6%]	0, [0%]	3, [9.6%]	72 [6.4%]	0, [0%]
Isolated Non-TBI Late VTE Prophylaxis (N, (%))	58389, [85.2%]	423, [86.5%]	19, [90.4%]	53 [92.9%]	1980, [88.9%]	13, [100%]	257 [89.5%]	6, [100%]	25 [80.6%]	1012 [90.2%]	2, [100%]

In-Hospital Mortality

The multivariable regression model was statistically significant (P < .01). Multicollinearity tests did not yield any tolerance values below .5. Several significant factors for race effects of in-hospital mortality were identified, which included Asian and Black races. Within the isolated TBI early VTE prophylaxis group, Asian patients were 16 times more likely to experience increased in-hospital mortality (OR 16.27, CI = 1.11-237.43, P = .04; Table 3), and received the lowest rate of VTE prophylaxis (3.7%) following Indian Americans (1.8%) as compared to Black (11.2%) and White (68.2%), (Table 1A). Within the isolated non-TBI late VTE prophylaxis group, Black patients were 40% less likely to experience in-hospital mortality (OR .60, CI = .36-.99, P = .04) than Asian, Pacific Islander, or White patients.

Table 3.

Multimodal Regression Analysis of Factors Associated With In-Hospital Mortality Among Adults (≥16 years) Who Did Not Expire in the ED With Moderate to Severe Blunt Injuries (ISS ≥9) that Were Administered VTE Prophylaxis (N = 68,504).

Dependent Variable	Effect	S.E.	OR	95% C.I. for OR		P-Value
Dependent Variable	Effect	S.E.	OR	Lower	Upper	P-Value
Isolated TBI Early VTE Prophylaxis	African American	28397.67	.00	.00	.00	1
	Asian	1.36	16.27	1.11	237.43	.04
	Pacific islander	1.35	4.22	.29	59.78	.28
	Caucasian	Reference group
Isolated TBI Late VTE Prophylaxis	African American	.53	.77	.27	2.19	.62
	Asian	.27	.94	.55	1.62	.83
	Pacific islander	.18	1.30	.90	1.87	.14
	Caucasian	Reference group
Isolated Non-TBI Late VTE Prophylaxis	African American	.75	1.08	.24	4.72	.91
	Asian	.33	1.79	.92	3.48	.08
	Pacific islander	.23	.89	.56	1.42	.63
	Caucasian	Reference group
Isolated Non-TBI Late VTE Prophylaxis	African American	.25	.60	.36	.99	.04
	Asian	.11	1.09	.88	1.36	.39
	Pacific islander	.07	1.03	.88	1.20	.66
	Caucasian	Reference group

Controlled Variables: Age, Ethnicity, Hypotensive, Sex, Race, VTE Type, Insurance, Mode of Transportation.

Discussion

This analysis revealed that race and VTE prophylaxis timing significantly impacted in-hospital mortality and the rate of DVT and PE following both isolated TBI and isolated non-TBI injuries in adult patients. Asian patients with isolated TBI who received early prophylaxis faced a risk of in-hospital mortality over 16 times that of other races. Patients receiving late VTE prophylaxis in both the isolated TBI and non-TBI groups had higher rates of DVT and PE compared to patients receiving early prophylaxis regardless of race. Patients with isolated TBI who received early prophylaxis had the lowest DVT and PE rates of all subgroups and were more likely to receive unfractionated heparin, compared to all other subgroups who were more likely to receive a LMWH. Interestingly, Black patients with non-TBI injuries demonstrated a lower likelihood of mortality compared to other races when they received late VTE prophylaxis. In TBI patients, early VTE prophylaxis correlated with increased age and no differences in race, whereas in non-TBI patients, early VTE prophylaxis correlated with younger age and increased incidence of Black race.

Existing literature has identified racial differences in VTE risk and subsequent prophylaxis management, specifically amongst Black and Asian populations. In Saber et al, authors found that Black patients had a higher incidence of VTE and were noted to be younger than their White counterparts (P < .0001).⁷ Similarly, our study revealed that individuals who exhibited severe body injuries and received early VTE prophylaxis were predominantly from the Black demographic and were of a younger age group. This trend is further substantiated by Zebley et al, whose research demonstrated that Black patients had the highest rates of VTE prophylaxis utilization, coupled with the shortest time to administration (1.6 days). 3 In the Asian demographic, a National Inpatient Sample study by Chen et al examined racial variations in VTE risk after major abdominal operations and concluded that a tailored approach to VTE prophylaxis might be necessary, given that Asian patients exhibited a higher risk-benefit ratio for postoperative VTE prophylaxis than White patients.⁸ Interestingly, in our investigation, Asian patients with isolated TBI faced a risk of in-hospital mortality over 16 times that of other races. Our analysis in the context of the studies above highlights additional racial differences in VTE prophylaxis and risks and supports that race should be taken into consideration when designing protocols for VTE prophylaxis.

In a recent study by Shulkosky et al utilizing the TQIP database, authors explored the influence of different VTE prophylaxis initiation timeframes on the incidence of VTE within TBI patients, finding that patients who underwent VTE prophylaxis initiation within the intervals of 48 to 72 hours and beyond 72 hours after admission had higher odds of experiencing VTE occurrences in contrast to patients with administration within the initial 24 hours.⁹ Our study supports this evidence, as analysis showed that patients who received late prophylaxis after 24 hours had significantly higher rates of DVT and PE compared to patients who received it early before 24 hours across all racial groups and independent of injury type. While the work by Shulkosky et al showed the benefit of early VTE prophylaxis in reducing VTE incidence within the TBI patient cohort, our investigation highlights that this finding is consistent across racial groups and injury types, additionally underscoring the necessity for individualized strategies that accommodate diverse patient attributes to yield optimized clinical outcomes.⁹

This analysis has implications for the administration of VTE prophylaxis in trauma patients. First, we aim for these findings to bring attention to the existence of racial disparities in clinical outcomes, allowing for the tailoring of treatment strategies based on more individual patient factors. The American Association for the Surgery of Trauma (AAST) and the American College of Surgeons-Committee on Trauma (ACS COT) released revised guidelines in 2022 that aimed at standardizing VTE prophylaxis in trauma patients.¹⁰ The comprehensive treatment algorithm takes many factors into account, such as injury type, active bleeding, creatinine, age, weight, and BMI, ultimately leading to a recommendation for both type and timing of prophylaxis. However, these recommendations do not account for race. Based on the findings of this study, we suggest additional studies be conducted to further delineate the impact of race on VTE prophylaxis outcomes to allow for further refinement of these guidelines. This includes investigating how race and the type of VTE prophylaxis may be associated with disparities in VTE risk as well as evaluating the causative factors for these disparities. This may ultimately lead to the testing of targeted interventions which may help to alleviate any disparity in outcomes following VTE prophylaxis. Future studies may also benefit from evaluating the intersection of race and rate of VTE prophylaxis administration, comparing between patients who did vs did not receive prophylaxis. Additionally, the results of this study support that health care systems should incorporate racial disparities in outcomes into quality metrics to allow for these disparities to be further quantified and eventually reduced.

This study has major limitations which should be considered when interpreting these findings. Firstly, the heterogeneity of mixed-race individuals can complicate efforts to categorize them into discrete racial groups, potentially diluting the clarity of racial disparities in clinical outcomes and reducing statistically significant results. Second, this study cannot correct for heterogeneity in the timing of initiation of VTE prophylaxis within the 2 subgroups, which may have been a confounding variable to the resulting clinical outcomes. Additionally, this study cannot correct for heterogeneity in severity amongst patients with isolated non-TBI as well as variations in the mechanism of injury for both TBI and non-TBI patients. Lastly, the very small sample size among Asian patients’ population with severe isolated TBI receiving early VTE prophylaxis should be highly considered when making an interpretation of mortality findings, thus further research is needed to investigate and validate these findings in the future.

This study revealed significant effects of race and VTE prophylaxis timing on incidence of complications and on in-hospital mortality amongst Asian and Black patients. Specifically, patients who received late VTE prophylaxis were more likely to have DVT and PE regardless of race or injury type. Additionally, despite receiving early VTE prophylaxis, Asian patients with isolated TBI were 16 times more likely to experience in-hospital mortality. TBI patients who received early prophylaxis had the lowest VTE risk and were more likely to receive unfractionated heparin compared to all other groups who were more likely to receive a LMWH. Future research should investigate other factors leading to these disparities in clinical outcomes, such as VTE prophylaxis type or socioeconomic status, and should explore more long-term outcomes following discharge to investigate the impact of race in these outcomes.

Conclusion

In this retrospective study of adult trauma patients analyzing early vs late VTE prophylaxis in patients with or without isolated TBI, Asian patients with isolated TBI were 16 times more likely to experience in-hospital mortality compared to other races despite having received early VTE prophylaxis. Patients who received late VTE prophylaxis had significantly higher rates of DVT and PE compared to patients who received early prophylaxis, regardless of injury pattern or race. Given these findings, further research is warranted to investigate other factors that influence the racial disparities in mortality and VTE rates to provide equitable clinical outcomes for patients of all races.

Supplemental Material

Supplemental Material - Racial Distribution and Associated Outcomes for Patients With and Without Severe-Isolated Traumatic Brain Injuries Following Venous Thromboembolism Prophylaxis

Supplemental Material for Racial Distribution and Associated Outcomes for Patients With and Without Severe-Isolated Traumatic Brain Injuries Following Venous Thromboembolism Prophylaxis by Adel Elkbuli, Heli Patel, Tessa Breeding, Hazem Nasef, Brian Chin, D-Dre Wright, Tracy Zito, Stephen R. Poulin, and Heather X. Rhodes-Lyons in The American Surgeon™

Footnotes

Acknowledgment

The authors would like to thank Glen Buth, trauma research programmer, and analyst at the Office of Research and Computing Analytics at the Marshfield Clinic Research Institute for preparing the dataset.

Author Contributions

Study design and conception: AE, HR, Data collection, analysis, and interpretations: AE, HR, Manuscript preparation and drafting: AE, HR, HP, TB, HN, BC, DR, SP, Critical revisions of the manuscript: AE, HR, HP, TB, HN, BC, DR, TZ.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: For author Dr. Heather Rhodes, Funding for this project was provided in part through philanthropic support of Marshfield Clinic Research Institute led by the Marshfield Clinic Health System Foundation.

Disclosure

The American College of Surgeons National Trauma Quality Improvement Program and the hospitals participating in the ACS TQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Supplemental Material

Supplemental material for this article is available online.

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, et al. American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma Clinical Protocol for inpatient venous thromboembolism prophylaxis after trauma. J Trauma Acute Care Surg. 2022;92(3):597-604.

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