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

Female patients with traumatic brain injury (TBI) are 26% less likely to be admitted to a specialized trauma center than male patients, according to a study of data from Ontario published in Canadian Medical Association Journal. This difference persisted even after researchers accounted for factors such as age, severity of injury, other health conditions and socioeconomic circumstances.

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

In this study, based on ICES data from 55,606 patients admitted to the hospital for TBI in Ontario between April 2009 and March 2020, 39% (21,719) were female. Of the total, 18,650 patients were admitted to a specialized trauma center, including 26% (5,666) of female patients and 38% (12,984) of male patients. Female patients were much older (median age 78 years) than male patients (median age 67 years) and were more likely to have dementia and hypertension. By contrast, male patients had higher rates of severe head trauma (33%) than female patients (25%).

Several factors may contribute to these differences 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 prehospital priority,” writes Dr. Natalia Angeloni, a critical care physician at Sunnybrook Health Sciences Centre and Ph.D. student at the University of Toronto, Toronto, Ontario, with co-authors. “Second, unconscious (implicit) sex-related bias may contribute to differential recognition of severity of injury.”

As well, the smaller number of female patients with TBI in research studies may contribute to a narrow understanding of the way trauma presents in female patients.

The authors suggest more research is needed to understand sex-based discrepancies in trauma care.

“In Ontario, triage performance is suboptimal, with high rates of both overtriage and undertriage, suggesting variability in decision-making, even when standardized guidelines are in place,” the authors write. “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.”

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Gaby Clark

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Robert Egan

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