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Racial Disparity in Placement of Intracranial Pressure Monitoring: A TQIP Analysis
The Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
The Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
Örebro University, School of Medical Sciences. Division of Trauma & Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-3583-3443
The Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
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2023 (English)In: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 236, no 1, p. 81-92Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: 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.

STUDY DESIGN: We queried the TQIP database from 2017 to 2019 and included patients 16 years or older, with blunt severe TBI, defined as a head abbreviated injury score 3 or greater. Exclusion criteria were missing race, those without signs of life on admission, length of stay 1 day or less, and AIS of 6 in any body region. The primary outcome was ICP monitor placement, which was calculated using a Poisson regression model with robust SEs while adjusting for confounders.

RESULTS: A total of 260,814 patients were included: 218,939 White, 29,873 Black, 8,322 Asian, 2,884 American Indian, and 796 Native Hawaiian or Other Pacific Islander. Asian and American Indian patients had the highest rates of midline shift (16.5% and 16.9%). Native Hawaiian or Other 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 incident rate ratio 1.19; 95% CI 1.06 to 1.33; p = 0.003], and American Indian patients were 38% less likely (adjusted incident rate ratio 0.62; 95% CI 0.49 to 0.79; p < 0.001), compared with White patients, respectively. No differences were detected between White and Black patients.

CONCLUSIONS: ICP monitoring use differs 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, 2023. Vol. 236, no 1, p. 81-92
National Category
Neurology
Identifiers
URN: urn:nbn:se:oru:diva-102752DOI: 10.1097/XCS.0000000000000455ISI: 000921231200016PubMedID: 36519911Scopus ID: 2-s2.0-85144182392OAI: oai:DiVA.org:oru-102752DiVA, id: diva2:1719820
Conference
108th Annual Clinical Congress and Scientific Forum of the American-College-of-Surgeons (ACS), San Diego, CA, USA, October 16-20, 2022
Available from: 2022-12-16 Created: 2022-12-16 Last updated: 2024-03-06Bibliographically approved

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Forssten, Maximilian PeterBass, Gary AlanMohseni, Shahin

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