Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations
Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
Department of Neurological Surgery, Columbia University of Physicians and Surgeons, New York, NY 10027, USA
Department of Neurological Surgery, Stanford University, Stanford, CA 94305, USA
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Brain Sci. 2020, 10(3), 135; https://doi.org/10.3390/brainsci10030135
Received: 10 January 2020 / Revised: 27 February 2020 / Accepted: 27 February 2020 / Published: 28 February 2020
(This article belongs to the Special Issue Health Disparities in Traumatic Brain Injury)
Introduction: Traumatic brain injury (TBI) remains a primary cause of pediatric morbidity. The improved characterization of healthcare disparities for pediatric TBI in United States (U.S.) rural communities is needed to advance care. Methods: The PubMed database was queried using keywords ((“brain/head trauma” OR “brain/head injury”) AND “rural/underserved” AND “pediatric/child”). All qualifying articles focusing on rural pediatric TBI, including the subtopics epidemiology (N = 3), intervention/healthcare cost (N = 6), and prevention (N = 1), were reviewed. Results: Rural pediatric TBIs were more likely to have increased trauma and head injury severity, with higher-velocity mechanisms (e.g., motor vehicle collisions). Rural patients were at risk of delays in care due to protracted transport times, inclement weather, and mis-triage to non-trauma centers. They were also more likely than urban patients to be unnecessarily transferred to another hospital, incurring greater costs. In general, rural centers had decreased access to mental health and/or specialist care, while the average healthcare costs were greater. Prevention efforts, such as mandating bicycle helmet use through education by the police department, showed improved compliance in children aged 5–12 years. Conclusions: U.S. rural pediatric patients are at higher risk of dangerous injury mechanisms, trauma severity, and TBI severity compared to urban. The barriers to care include protracted transport times, transfer to less-resourced centers, increased healthcare costs, missing data, and decreased access to mental health and/or specialty care during hospitalization and follow-up. Preventative efforts can be successful and will require an improved multidisciplinary awareness and education.