Racial Disparities for Pediatric Traumatic Brain Injury Patients, Treatment and Mortality
Melanie B. LaPlant, MPH; Daniel A. Saltzman, MD, PhD; Robert D. Acton, MD; Bradley J. Segura, MD, PhD; Donavon J. Hess, MD, PhD, MBA
University of Minnesota, Minneapolis, MN
Introduction: Significant disparities exist among trauma patients in the United States. Previous research has identified worse outcomes for minority pediatric traumatic brain injury (TBI) patients. We sought to evaluate investigate the relationship between procedure utilization, race/ethnicity, and mortality for pediatric TBI patients.
Methods: NTDB data (2010-2016) for patients aged (1 to 18y) with a severe (GCS 3 -8) TBI were evaluated (17,612 patients). Neurosurgical procedure utilization and mortality by race/ethnicity were evaluated using multivariate logistic regression adjusting for patient demographics, injury type and severity, and facility characteristics.
Results: Black/African American (B/AA) patients were 19% less likely to receive at least one procedure compared to white patients (AOR 0.81, 95% CI 0.74 • 0.88, p < .001). Specifically, B/AA patients were 29% less likely to receive a decompressive craniectomy (AOR 0.71, 95% CI 0.62 • 0.82, p < .001). B/AA patients were 21% more likely to expire (AOR 1.21, 95% CI 1.09 • 1.35, p < .001). Across all races, patients who did not receive a procedure were 93% more likely to expire compared to patients who did (AOR 1.93, 95% CI 1.76 • 2.10, p < .001). Further, we found no mortality disparity among patients that received a procedure, but among patients that did not receive a procedure, B/AA patients were 37% more likely to expire (AOR 1.37, 95% CI 1.19 • 1.57, p < .001).
Conclusion: We found significant disparities for pediatric TBI patients in treatment and mortality. Further research should evaluate health disparities in both treatment and outcomes.
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