Racial Disparities in Limb Amputations After Traumatic Vascular Injury
Christina Tse1, Areg Grigorian, M.D.1, Jeffry Nahmias, M.D.1, Nii-Kabu Kabutey, M.D.1, Sebastian Schubl, M.D.1, Brian Beckord, M.D.2, Nina Bowens, M.D.2, Christian de Virgilio, M.D.2.
1University of California, Irvine, Orange, CA, USA, 2University of California, Los Angeles - Harbor, Torrance, CA, USA.
OBJECTIVES: The influence of race/ethnicity on limb loss after traumatic vascular injury is unclear. Black U.S. soldiers are more vulnerable to developing rhabdomyolysis, presumably due to a higher incidence of sickle cell trait. As such, we hypothesized that Black race would have higher risk for limb loss after axillosubclavian, femoral and popliteal artery injury in a large national database.
METHODS: The National Trauma Data Bank was queried for patients > 16 years of age with axillosubclavian, femoral and popliteal artery injury to determine the risk of arm, above knee, and below knee amputation, respectively. Covariates were included in separate multivariable logistic regression models for analysis.
RESULTS: From 5,683,057 patients, 21,202 were identified with axillosubclavian, femoral or popliteal artery injury (<0.4%). For axillosubclavian injury, American-Indian race was associated with higher risk for upper-extremity amputation as compared to whites (OR=5.10, CI=1.62-16.06, p<0.05). For femoral artery injury, Black race (OR=0.66, CI=0.49-0.89, p<0.05) was associated with lower risk of above the knee amputation, compared to whites. For, popliteal artery injury, race was not associated with risk for below-the-knee amputation.
CONCLUSIONS: Black race is associated with a lower risk of above-the-knee amputation after femoral artery injury. Compare to whites, American-Indian race was associated with a five-fold higher risk for upper-extremity amputation after axillosubclavian artery injury. Race was not associated with a risk for limb loss after popliteal artery injury. Future prospective studies examining socioeconomic factors and access to healthcare within this patient population is warranted to identify barriers and areas of improvement.
| Risk factor | OR | CI | p value |
| American Indian | 5.10 | 1.62-16.06 | <0.05 |
| Black | 0.72 | 0.40-1.32 | 0.29 |
| Asian | 0.28 | 0.03-2.57 | 0.26 |
| Hispanic or Latino | 0.82 | 0.28-2.38 | 0.72 |
| Risk factor | OR | CI | p value |
| American Indian | 1.36 | 0.52-3.51 | 0.53 |
| Black | 0.66 | 0.49-0.89 | <0.05 |
| Asian | 0.28 | 0.07-1.18 | 0.08 |
| Hispanic or Latino | 0.73 | 0.40-1.36 | 0.32 |
| Risk factor | OR | CI | p value |
| American Indian | 0.69 | 0.17-2.92 | 0.62 |
| Black | 1.10 | 0.81-1.48 | 0.55 |
| Asian | 0.96 | 0.34-2.72 | 0.95 |
| Hispanic or Latino | 0.83 | 0.45-1.54 | 0.55 |
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