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Published on: January 30, 2018
Short-Term Outcomes of Ethnic and Racial Minority Pediatric Patients Following Traumatic Brain Injury in the State of
Colin Son1, Izabela Tarasiewicz2
1Neurosurgery, Neurosurgical Associates of San Antonio, San Antonio, USA.
Insights
Racial and ethnic minority children with traumatic brain injuries in Texas experience worse outcomes. These disparities in mortality and rehabilitation access persist after accounting for insurance and injury severity.
Area of Science:
- Pediatric Traumatic Brain Injury
- Health Disparities
- Healthcare Outcomes
Background:
- Traumatic brain injury (TBI) in children is a major cause of death and disability.
- Healthcare disparities are known to affect ethnic and racial minorities in the U.S.
- The impact of these disparities on pediatric TBI outcomes has not been previously evaluated.
Purpose of the Study:
- To evaluate healthcare disparities in pediatric traumatic brain injury (TBI) outcomes.
- To analyze the influence of race and ethnicity on TBI outcomes in children.
- To identify differences in mortality and discharge disposition based on race and ethnicity.
Main Methods:
- Utilized a statewide database of civilian hospital admissions from 2006-2011.
- Included patients aged 0-17 years with traumatic brain injuries (ICD-9 codes).
- Analyzed demographic data (race, ethnicity, insurance) and illness severity (APR-DRG) against discharge disposition.
Main Results:
- 14,087 pediatric TBI admissions were analyzed.
- Minority pediatric TBI patients had higher in-hospital mortality (4.2% vs. 3.3%, p=0.009).
- Minority patients were less likely to be discharged to inpatient rehabilitation (2.9% vs. 4%, p<0.001).
Conclusions:
- Ethnic and racial minority children in Texas experience worse short-term outcomes after TBI.
- These disparities in TBI outcomes persist regardless of insurance status or illness severity.
- Targeted strategies are necessary to address and mitigate these healthcare disparities in pediatric TBI care.
Abstract:
Background Pediatric traumatic brain injury represents a significant cause of morbidity and mortality. Broadly healthcare disparities exist for ethnic and racial minorities in the United States but it has not previously be evaluated how these disparities might influence outcomes in pediatric traumatic brain injury. Methods We sought all hospital admissions between the years 2006 and 2011 for patients aged 0-17 years admitted with traumatic brain injuries as identified by the International Classification of Diseases, 9th Revision (ICD-9) code, from a statewide database of all civilian hospital admissions. Demographic information including race, ethnicity, insurance status and illness severity as calculated by All Patient Refined-Diagnosis Related Group (APR-DRG) were analysed versus the disposition at discharge. Results 14,087 pediatric traumatic brain injury patients were admitted between 2006 and 2011. Pediatric traumatic brain injury patients of ethnic or racial minority had higher rates of in-hospital mortality as compared to whites (4.2% versus 3.3%, p = 0.009) and were less likely to be discharged to inpatient rehabilitation (2.9% versus 4%, p < 0.001). These disparities persisted even when controlling for insurance status and illness severity. Conclusion Ethnic and racial minority children from the U.S. state of Texas suffer worse short-term outcomes following traumatic brain injury than their white counterparts. Strategies are needed for addressing this disparity.
