Racial Disparity in Placement of Intracranial Pressure Monitoring: A TQIP Analysis

Authors

James A. Zebley, From the Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC (Zebley, Estroff, Leighton, Sarani).
Jordan M. Estroff, From the Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC (Zebley, Estroff, Leighton, Sarani).
Maximilian Peter Forssten, School of Medical Sciences, Orebro University, Orebro, Sweden (Forssten, Bass, Mohseni).
Nicolas Leighton, From the Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC (Zebley, Estroff, Leighton, Sarani).
Gary Alan Bass, School of Medical Sciences, Orebro University, Orebro, Sweden (Forssten, Bass, Mohseni).
Babak Sarani, From the Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC (Zebley, Estroff, Leighton, Sarani).
Shahin Mohseni, School of Medical Sciences, Orebro University, Orebro, Sweden (Forssten, Bass, Mohseni).

Document Type

Journal Article

Publication Date

1-1-2023

Journal

Journal of the American College of Surgeons

Volume

236

Issue

1

DOI

10.1097/XCS.0000000000000455

Abstract

BACKGROUND: The Brain Trauma Foundation recommends intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Race is associated with worse outcomes after TBI. The reasons for racial disparities in clinical decision-making around ICP monitor placement remain unclear. STUDY DESIGN: We queried the TQIP database from 2017 to 2019 and included patients 16 years or older, with blunt severe TBI, defined as a head abbreviated injury score 3 or greater. Exclusion criteria were missing race, those without signs of life on admission, length of stay 1 day or less, and AIS of 6 in any body region. The primary outcome was ICP monitor placement, which was calculated using a Poisson regression model with robust SEs while adjusting for confounders. RESULTS: A total of 260,814 patients were included: 218,939 White, 29,873 Black, 8,322 Asian, 2,884 American Indian, and 796 Native Hawaiian or Other Pacific Islander. Asian and American Indian patients had the highest rates of midline shift (16.5% and 16.9%). Native Hawaiian or Other Pacific Islanders had the highest rates of neurosurgical intervention (19.3%) and ICP monitor placement (6.5%). Asian patients were found to be 19% more likely to receive ICP monitoring (adjusted incident rate ratio 1.19; 95% CI 1.06 to 1.33; p = 0.003], and American Indian patients were 38% less likely (adjusted incident rate ratio 0.62; 95% CI 0.49 to 0.79; p < 0.001), compared with White patients, respectively. No differences were detected between White and Black patients. CONCLUSIONS: ICP monitoring use differs by race. Further work is needed to elucidate modifiable causes of this difference in the management of severe TBI.

APA Citation

Zebley, James A.; Estroff, Jordan M.; Forssten, Maximilian Peter; Leighton, Nicolas; Bass, Gary Alan; Sarani, Babak; and Mohseni, Shahin, "Racial Disparity in Placement of Intracranial Pressure Monitoring: A TQIP Analysis" (2023). GW Authored Works. Paper 2041.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2041

Department

Surgery