Time to Surgery for Traumatic Epidural Hematoma by Race and Insurance Payor

Introduction: Prior studies have demonstrated an association between socioeconomic status and quality of care in Traumatic Brain Injury (TBI). Favorable outcomes in traumatic epidural hematoma (EDH) depend on prompt recognition and intervention, making it crucial to investigate potential disparities in management. The current study aims to investigate the association of race and insurance payor with time to surgery in patients with traumatic EDH.

Methods: All patients with EDH and GCS < 8 between 2019-2021 were identified from the National Trauma Data Bank (NTDB). Multivariate linear regression was used to examine the association between race and insurance payor with time from presentation to surgical intervention. Time to surgery was transformed using a natural logarithm to meet assumptions of linearity. Sex, GCS (verbal, eye, and motor), coagulopathy, anticoagulation, hospital transfer, and multiple comorbidities with known race associations were analyzed as predictor variables.

Results: Among the 637 identified patients, black race was the strongest predictor of increased time to surgery (coefficient=0.49, p=0.003). Hypertension and the presence of midline shift were also significantly associated with a longer time to surgery (coefficient=0.19, p=0.031; coefficient=0.17, p=0.013). Insurance payor was not significantly associated with time to surgery.

Conclusion : These results suggest that race may influence time to surgery independently of medical comorbidities. Identifying and addressing implicit and explicit racial biases is essential to providing equitable care and improving outcomes in emergent conditions such as EDH. Ongoing studies at our institution investigate patient-centered outcomes in patients with EDH, including the association of race and time to surgery.