Demographic Differences in the Neurosurgical Management of Traumatic Brain Injuries: A National Database Analysis

Introduction: TBIs represent a significant public health concern, with a substantial impact on mortality, disability. Increasing evidence indicates the presence of racial and ethnic disparities within the realm of TBI care. This study aims to investigate potential differences in the surgical management of TBI based on racial factors.

Methods: The National Trauma Data Bank was queried from 2017 to 2019 for all patients with a TBI who underwent subsequent neurosurgical intervention.Parameters such as modes of transportation, emergency medical services (EMS) dispatch times, and time spent at the scene were computed from the moment of the incident. Statistical analyses, including one-way ANOVA with post-hoc tukey tests and Chi-squared tests, were conducted to compare patient demographics, in-hospital complications, and time elapsed before surgery between the different racial groups.

Results: A total of 784,831 patients with a TBI were identified, out of which 7504 patients underwent a subsequent craniectomy or craniotomy. Majority of the injuries resulted from blunt traumas. Time from incident to EMS arrival was significantly longer for Asian patients. White patients had the longest EMS time at scene, and they had the highest proportion of patients transported via ground ambulance (p < 0.05 for all). No significant differences in GCS were observed. The average time to craniotomy and craniectomy was 94.0 and 37.70 hours, respectively, with no significant variations based on race. Additionally, there were no significant differences in mortality rates.

Conclusion : To our knowledge, this is the largest study investigating the relationship between race and medical interventions affecting outcomes for patients with a TBI. Although we discovered notable disparities in EMS times, no significant differences were found in surgical outcomes or time to surgery based on racial factors. Nonetheless, it is imperative to conduct further analyses to assess the potential impact of other biases affecting the delivery of medical care.