Female TBI patients less likely to be admitted to specialist trauma centres – study

Female TBI patients were 26 per cent less likely than males to be admitted to specialist trauma centres, Ontario data suggests.

The gap remained after researchers adjusted for age, injury severity, other health conditions and socioeconomic circumstances.

The study analysed 55,606 patients admitted to hospital for TBI in Ontario between April 2009 and March 2020. Of these, 39 per cent, or 21,719, were female.

A total of 18,650 patients were admitted to a specialist trauma centre. This included 26 per cent of female patients, or 5,666, compared with 38 per cent of male patients, or 12,984.

Female patients were older, with a median age of 78, compared with 67 for males, and were more likely to have dementia and hypertension, or high blood pressure.

Male patients had higher rates of severe head trauma, at 33 per cent, compared with 25 per cent among female patients.

Researchers said several factors may explain the difference 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,” wrote Dr Natalia Angeloni, a critical care physician at Sunnybrook Health Sciences Centre and PhD student at the University of Toronto, with co-authors.

“Second, unconscious (implicit) sex-related bias may contribute to differential recognition of severity of injury.”

The authors said smaller numbers of female TBI patients in research studies may also limit understanding of how trauma presents in females.

They called for more research into sex-based differences in trauma care.

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

“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.”

Undertriage means a patient who may need specialist trauma care is not sent to the right level of service. Overtriage means a patient is sent for specialist care when it may not be needed.