Female patients with traumatic brain injury less likely to be admitted to trauma centres

A University of Toronto-led study has shown that in patients with traumatic brain injury (TBI), female patients are 26 per cent less likely to be admitted to a specialized trauma centre than males. This difference persisted even after the researchers accounted for factors such as age, severity of injury, other health conditions, and socioeconomic circumstances.

Recently published in the Canadian Medical Association Journal (CMAJ), the study authors suggest several factors may contribute to the variations in admission rates.

“First, injuries in female patients are more often associated with lower-energy mechanisms, such as ground-level falls, that may attract less attention and may lead to lower pre-hospital priority,” says study first author Natalia Angeloni, who recently completed clinical fellowships in critical care medicine and plastic surgery with U of T's Temerty Faculty of Medicine and is a PhD student at U of T’s Institute of Health Policy, Management, and Evaluation. “Second, unconscious (implicit) sex-related bias may contribute to differential recognition of severity of injury.”

Angeloni and her co-investigators — which included senior author Neill Adkihari, an associate professor in the interdepartmental division of critical care medicine — also suggest that the smaller numbers of female patients with TBI involved in research studies may contribute to a more limited understanding of the way trauma presents in females and proposed further research to understand sex-based differences in trauma care.

The study was based on ICES data of 55,606 patients admitted to hospital for TBI in Ontario between April 2009 and March 2020, of which 39 per cent (21,719) self-reported as female. Overall, 18,650 patients were admitted to a specialized trauma centre, with 26 per cent (n=5,666) of females and 38 per cent (n=12,984) of males admitted.

“In Ontario, triage performance is suboptimal, with high rates of both over-triage and under-triage, suggesting variability in decision-making, even when standardized guidelines are in place,” say the study authors. “Understanding how this variability interacts with sex and gender is critical. The role, if any, of conscious and unconscious bias in clinical decision-making in care of patients with TBI should be explored, as has been done for other clinical conditions; results should guide targeted interventions to reduce the disparities we have identified.”

Traumatic brain injuries, often from falls, are the leading cause of trauma-related death and disability globally.

This research was supported by the Canadian Institutes of Health Research and the Sunnybrook Research Institute Kimel-Schatzky Traumatic Brain Injury Research & Innovation Competition.