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Racial disparities and the acute management of severe blunt traumatic brain injury
  1. Rohit Sharma1,
  2. Arianne Johnson1,
  3. Jing Li2,
  4. Zach DeBoard1,
  5. Isabella Zikakis2,
  6. Jonathan Grotts2,
  7. Stephen Kaminski1
  1. 1Trauma, Santa Barbara Cottage Hospital, Santa Barbara, California, USA
  2. 2Research, Santa Barbara Cottage Hospital, Santa Barbara, California, USA
  1. Correspondence to Dr Rohit Sharma, Trauma, Santa Barbara Cottage Hospital, Santa Barbara, California 93015, USA; rsharma{at}sbch.org

Abstract

Background Traumatic brain injury (TBI) is a significant source of morbidity and mortality. In patients with TBI, racial disparities have been shown to exist in patient outcomes. Identifying where disparities occur along the patient continuum of care will allow for targeted interventions. This study evaluated if racial disparity exists for neuromonitoring and neurointervention rates in patients with severe TBI due to blunt injury.

Methods The National Trauma Data Bank was used to identify patients aged 18 to 55 years old from 2007 through 2016 with a blunt injury, an initial Glasgow Coma Scale score of 3 to 8, a head Abbreviated Injury Scale score of 3 to 5, and all other anatomic Abbreviated Injury Scale scores less than 3. Coarsened exact matching (CEM) was used to balance covariates between white and non-white patients. Rates of neuromonitoring and neurosurgical interventions were compared between groups. Secondary outcomes were days spent in the intensive care unit (ICU), total hospital length of stay (LOS), and mortality.

Results A total of 3692 patients with severe isolated TBI due to blunt injury were identified. After applying CEM, 1064 patients were analyzed (644 white, 420 non-white). No differences were observed between white and non-white patient groups for neuromonitoring, neurointervention, mortality, or ICU LOS. White patients had a shorter hospital LOS (8 days vs. 9 days, p<0.05) than non-white patients.

Discussion For severe isolated blunt TBI, neuromonitoring, neurointervention, and mortality rates were similar for white and non-white patients. Although racial disparities in patient outcomes exist, these differences do not seem to be due to neuromonitoring and neurointervention rates for management of TBI.

Level of evidence Level III.

  • brain injuries
  • Racial disparities
  • neurosurgery
  • outcomes research

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors Study design: ZD, SK, JG, AJ, JL, RS. Literature search: ZD, JG, SK, RS, JL, IZ. Data collection: JL, JG. Data analysis: JL, ZD, JG, AJ, SK, RS. Writing: ZD, JG, JL, AJ, RS, IZ. Critical revision: AJ, RS, JL, SK, IZ.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the institutional review board at Santa Barbara Cottage Hospital and a waiver of informed consent was granted.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.

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