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Racial Disparities in the Placement of Intracranial Monitoring: A TQIP Analysis
Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington DC, USA.
Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington DC, USA.
Örebro University, School of Medical Sciences.ORCID iD: 0000-0003-3583-3443
Örebro University, School of Medical Sciences.ORCID iD: 0000-0002-1918-9443
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2022 (English)In: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 235, no 5 Suppl. 2, p. S96-S96Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: The Brain Trauma Foundation recommends intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Race is associated with worse outcomes after TBI. The reasons for racial disparities in clinical decision-making around ICP monitor placement remain unclear.

Methods: We queried the Trauma Quality Improvement Project (TQIP) database from 2017-2019 and included patients ≥16 years old, with blunt severe TBI. Exclusion criteria was no recorded race, those without signs of life, had length of stay <1 day and AIS=6 in any body region. Variables included demographic, clinical, and outcome characteristics. The primary outcome was probability of ICP-monitor placement. We calculated incidence rate ratios for ICP monitor placement using a Poisson regression model to adjust for confounders.

Results: A total of 260,814 patients were included: 218,939 White, 29,873 Black, 8,322 Asian, 2,884 Native American, and 796 Pacific Islander. Asian and Native American patients had the highest rates of midline shift (16.5% and 16.9%). Pacific Islanders had the highest rates of neurosurgical intervention (19.3%) and ICP monitor placement (6.5%). Asian patients were found to be 19% more likely to receive ICP monitoring [adjusted IRR 1.19 (95%CI: 1.06-1.33), p = 0.003], while Native American patients were 38% less likely [adjusted IRR 0.62 (95%CI: 0.49-0.79), p < 0.001], compared with White patients, respectively. No differences were detected between White and Black patients.

Conclusion: ICP monitoring use differs significantly by race. Further work is needed to elucidate modifiable causes of this difference in the management of severe TBI.

Place, publisher, year, edition, pages
Elsevier, 2022. Vol. 235, no 5 Suppl. 2, p. S96-S96
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Surgery
Identifiers
URN: urn:nbn:se:oru:diva-102029DOI: 10.1097/01.XCS.0000896552.61922.31ISI: 000867877000241OAI: oai:DiVA.org:oru-102029DiVA, id: diva2:1708092
Conference
The American College of Surgeons 2022 Annual Clinical Congress, San Diego, CA, USA, October 16-20, 2022
Available from: 2022-11-02 Created: 2022-11-02 Last updated: 2024-03-06Bibliographically approved

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Forssten, Maximilian PeterBass, Gary AlanMohseni, Shahin

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