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Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
Published on: August 16, 2019
Urban/Rural disparities in Oregon pediatric traumatic brain injury
Megan J Leonhard1, Dagan A Wright2, Rongwei Fu3
1Department of Public Health and Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098 USA.
Insights
Children in rural areas experience higher rates of traumatic brain injury (TBI) and are more likely to die from TBI compared to urban children. This highlights critical urban/rural disparities in pediatric TBI outcomes.
Area of Science:
- Public Health
- Pediatric Traumatology
- Epidemiology
Background:
- Traumatic brain injury (TBI) is a significant cause of death and disability in children.
- Urban and rural populations may experience different TBI incidence and mortality rates.
- Understanding these disparities is crucial for developing targeted interventions.
Purpose of the Study:
- To investigate urban/rural differences in mortality among pediatric patients with TBI in Oregon.
- To identify potential disparities in TBI incidence and outcomes based on geographic location.
Main Methods:
- Retrospective analysis of pediatric TBI cases (ages 0-19) from the Oregon Trauma Registry (2009-2012).
- Classification of injury location using the National Center for Health Statistics Urban/Rural Classification Scheme.
- Multivariable logistic regression and generalized estimating equations to assess associations between location and mortality, controlling for confounders.
Main Results:
- Pediatric TBI incidence was higher in rural areas (107/100,000) compared to large metropolitan areas (71/100,000).
- Children with rural TBI had over twice the crude odds of mortality (OR, 2.5) compared to urban children.
- This association remained significant after adjusting for demographic and injury-specific factors (OR, 1.8).
Conclusions:
- Higher rates of TBI and more severe injuries were observed in rural Oregon compared to urban areas.
- Rural pediatric TBI patients faced increased mortality risk within the trauma system, even after accounting for other factors.
- Further research is needed to address treatment disparities and develop interventions to reduce TBI-related mortality in rural children.
Background:
Traumatic brain injury (TBI) greatly contributes to morbidity and mortality in the pediatric population. We examined potential urban/rural disparities in mortality amongst Oregon pediatric patients with TBI treated in trauma hospitals.
Methods:
We conducted a retrospective study of children ages 0-19 using the Oregon Trauma Registry for years 2009-2012. Geographic location of injury was classified using the National Center for Health Statistics Urban/Rural Classification Scheme. Incidence rates were calculated using Census data for denominators. Associations between urban/rural injury location and mortality were assessed using multivariable logistic regression, controlling for potential confounders. Generalized estimating equations were used to help account for clustering of data within hospitals.
Results:
Of 2794 pediatric patients with TBI, 46.6 % were injured in large metropolitan locations, 24.8 % in medium/small metropolitan locations, and 28.6 % in non-metropolitan (rural) locations. Children with rural locations of injury had a greater annualized TBI incidence rate, at 107/100,000 children per year, than those from large metropolitan areas (71/100,000 per year). Compared to children injured in urban locations, those in rural locations had more than twice the crude odds of mortality (odds ratio [OR], 2.5; 95 % CI, 1.6-4.0). This association remained significant (OR, 1.8; 95 % CI, 1.04-3.3) while adjusting for age, gender, race, insurance status, injury severity, and type of TBI (blunt vs. penetrating).
Conclusion:
We observed higher rates of TBI and greater proportions of severe injury in rural compared to urban areas in Oregon. Rural children treated in the trauma system for TBI were more likely to die than urban children after controlling for demographic and injury factors associated with urban/rural residence. Further research is needed to examine treatment disparities by urban/rural location. Future work should also identify interventions that can reduce risk of TBI and TBI-related mortality among children, particularly those who live in rural areas.
