Female patients with traumatic brain injury (TBI) are 26 per cent less likely to be admitted to a specialized trauma center than men, according to a study of data published in Ontario. CMJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251721. This difference persisted even after researchers took into account factors such as age, injury severity, other health conditions, and socioeconomic status.
Traumatic brain injuries (often due to falls) are the leading cause of trauma-related death and disability worldwide.
The study, based on ICES data of 55,606 patients hospitalized for traumatic brain injury in Ontario between April 2009 and March 2020, found that 39% (21,719 patients) were women. Of this total, 18,650 patients were admitted to specialized trauma centers, including 26% (5,666) of women and 38% (12,984) of men. Female patients were much older (median age 78 years) and more likely to have dementia and hypertension than men (median age 67 years). In contrast, male patients had a higher proportion of severe head injuries (33%) than females (25%).
Several factors may contribute to these fluctuations in enrollment rates.
”First, injuries in female patients are often associated with low-energy mechanisms, such as falls from the ground, and therefore may receive less attention and receive lower prehospital priority.” wrote Dr. Natalia Angeloni, a critical care physician at Sunnybrook Health Sciences Center and a doctoral student at the University of Toronto in Toronto, Ontario, along with co-authors.Second, unconscious (implicit) gender-related biases may contribute to differences in perceptions of injury severity.”
Similarly, the small number of female patients with TBI in research studies may contribute to a narrow understanding of how trauma manifests in women.
The authors suggest that further research is needed to understand gender differences in trauma care.
“Triage performance in Ontario was suboptimal, with high rates of both over- and under-triage, suggesting variation in decision-making even when standardized guidelines are in place,” the authors wrote. “It is important to understand how this variation interacts with sex and gender. We need to investigate the role, if any, of conscious and unconscious bias in clinical decision-making in the treatment of patients with traumatic brain injury, as has been done for other clinical conditions. The results should guide targeted interventions to reduce the disparities we have identified.”
sauce:
Canadian Medical Association Journal
