Do Racial and Ethnic Disparities Exist in Intensity of Intracranial Pressure–Directed Therapies and Outcomes Following Pediatric Severe Traumatic Brain Injury?

Abstract

Introduction

Studies suggest disparities in outcomes in minoritized children after severe traumatic brain injury. We aimed to evaluate for disparities in intracranial pressure–directed therapies and outcomes after pediatric severe traumatic brain injury.

Methods

We conducted a secondary analysis of the Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial, which enrolled pediatric severe traumatic brain injury patients (Glasgow Coma Scale score  ≤8) with an intracranial pressure monitor from 2014 to 2018. Patients admitted outside of the United States were excluded. Patients were categorized by race and ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White, and “Other”). We evaluated outcomes by assessing mortality and 3-month Glasgow Outcome Score–Extended for Pediatrics. Our analysis involved parametric and nonparametric testing.

Main Results

A total of 671 children were analyzed. Significant associations included older age in non-Hispanic White patients (P < .001), more surgical evacuations in “Other” (P < .001), and differences in discharge location (P = .040). The “other” cohort received hyperventilation less frequently (P = .046), although clinical status during Paco₂ measurement was not known. There were no other significant differences in intracranial pressure–directed therapies. Hispanic ethnicity was associated with lower mortality (P = .004) but did not differ in unfavorable outcome (P = .810). Glasgow Outcome Score–Extended for Pediatrics was less likely to be collected for non-Hispanic Black patients (69%; P = .011).

Conclusions

Our analysis suggests a general lack of disparities in intracranial pressure–directed therapies and outcomes in children after severe traumatic brain injury. Lower mortality in Hispanic patients without a concurrent decrease in unfavorable outcomes, and lower availability of Glasgow Outcome Score–Extended for Pediatrics score for non-Hispanic Black patients merit further investigation.