Influence of Insurance Status on Subdural Hematoma Management: A National Trauma Data Bank Analysis

Area of Science:

• Trauma surgery
• Public health
• Health services research

Background:

• Traumatic brain injury (TBI) and subdural hematomas (SDH) are significant public health issues.
• Previous research has not specifically examined insurance status's role in SDH treatment and outcomes.
• Social determinants of health, including insurance, may influence patient care.

Purpose of the Study:

• To investigate the association between insurance status and the management of traumatic subdural hematomas (SDH).
• To determine if insurance status impacts surgical intervention versus intracranial pressure (ICP)/external ventricular drain (EVD) monitoring for SDH.
• To analyze the effect of insurance on patient outcomes, including length of stay and mortality.

Main Methods:

• Retrospective analysis of the National Trauma Data Bank (2012-2016).
• Inclusion of 68,687 adult patients with a single diagnosis of subdural hematoma.
• Statistical adjustment for demographic factors, injury severity, and other clinical variables.

Main Results:

• Publicly insured patients were 1.86 times more likely to undergo craniotomy/craniectomy than self-pay patients.
• Insurance status did not significantly influence the likelihood of receiving ICP/EVD monitoring.
• No significant differences were observed in emergency department, hospital, or ICU length of stay between insurance groups.

Conclusions:

• Public insurance is associated with higher odds of surgical management for traumatic SDH.
• Further research is needed to understand the implications of insurance status on SDH treatment and outcomes.
• Findings highlight potential disparities in care influenced by socioeconomic factors.