Do Racial and Ethnic Disparities Exist in Intensity of Intracranial Pressure–Directed Therapies and Outcomes Following Pediatric Severe Traumatic Brain Injury?
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...
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| Veröffentlicht in: | Journal of child neurology 2024-06, Vol.39 (7-8), p.275-284 |
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| creator | Schopman, Lauren E. Land, Megan E. Rakkar, Jaskaran Appavu, Brian L. Buttram, Sandra D.W. |
| description | 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 |
| doi_str_mv | 10.1177/08830738241269128 |
| format | Article |
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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.</description><identifier>ISSN: 0883-0738</identifier><identifier>ISSN: 1708-8283</identifier><identifier>EISSN: 1708-8283</identifier><identifier>DOI: 10.1177/08830738241269128</identifier><identifier>PMID: 39246040</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adolescent ; Black or African American - statistics & numerical data ; Brain Injuries, Traumatic - ethnology ; Brain Injuries, Traumatic - mortality ; Brain Injuries, Traumatic - therapy ; Child ; Child, Preschool ; Ethnicity ; Female ; Glasgow Outcome Scale ; Healthcare Disparities - ethnology ; Healthcare Disparities - statistics & numerical data ; Hispanic or Latino - statistics & numerical data ; Humans ; Infant ; Intracranial Pressure - physiology ; Male ; Treatment Outcome ; White People - statistics & numerical data</subject><ispartof>Journal of child neurology, 2024-06, Vol.39 (7-8), p.275-284</ispartof><rights>The Author(s) 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c222t-9119a2b837d3001b521d889e71ed82eae6f0e434555685c5859e8a657bfb499c3</cites><orcidid>0009-0007-5409-6633 ; 0000-0002-5396-2559</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/08830738241269128$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/08830738241269128$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21818,27923,27924,43620,43621</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39246040$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schopman, Lauren E.</creatorcontrib><creatorcontrib>Land, Megan E.</creatorcontrib><creatorcontrib>Rakkar, Jaskaran</creatorcontrib><creatorcontrib>Appavu, Brian L.</creatorcontrib><creatorcontrib>Buttram, Sandra D.W.</creatorcontrib><title>Do Racial and Ethnic Disparities Exist in Intensity of Intracranial Pressure–Directed Therapies and Outcomes Following Pediatric Severe Traumatic Brain Injury?</title><title>Journal of child neurology</title><addtitle>J Child Neurol</addtitle><description>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.</description><subject>Adolescent</subject><subject>Black or African American - statistics & numerical data</subject><subject>Brain Injuries, Traumatic - ethnology</subject><subject>Brain Injuries, Traumatic - mortality</subject><subject>Brain Injuries, Traumatic - therapy</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Glasgow Outcome Scale</subject><subject>Healthcare Disparities - ethnology</subject><subject>Healthcare Disparities - statistics & numerical data</subject><subject>Hispanic or Latino - statistics & numerical data</subject><subject>Humans</subject><subject>Infant</subject><subject>Intracranial Pressure - physiology</subject><subject>Male</subject><subject>Treatment Outcome</subject><subject>White People - statistics & numerical data</subject><issn>0883-0738</issn><issn>1708-8283</issn><issn>1708-8283</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1uFDEQhS1ERCaBA7BBXrLp4J_-sVcIMhMSKVIiGNYtt7s68ajbHsruwOxyB07A1ThJupmEDRKrUpW_90rlR8hrzk44r6p3TCnJKqlEzkWpuVDPyIJXTGVKKPmcLOb3bAYOyVGMG8aYKjR7QQ6lFnnJcrYgv5aBfjbWmZ4a39JVuvXO0qWLW4MuOYh09cPFRJ2nFz6Bjy7taOjmBo1F42flNUKMI8Lv-59Lh2ATtHR9C2i2s8HsezUmG4apOQt9H747f0OvoXUm4bTtC9wBAl2jGQeTpsFHNH_2bUbcvX9JDjrTR3j1WI_J17PV-vQ8u7z6dHH64TKzQoiUac61EY2SVSsZ400heKuUhopDqwQYKDsGucyLoihVYYvpJ0CZsqiarsm1tvKYvN37bjF8GyGmenDRQt8bD2GMteRMsFIrISeU71GLIUaErt6iGwzuas7qOZn6n2QmzZtH-7EZoP2reIpiAk72QDQ3UG_CiH469z-ODzkcmLU</recordid><startdate>202406</startdate><enddate>202406</enddate><creator>Schopman, Lauren E.</creator><creator>Land, Megan E.</creator><creator>Rakkar, Jaskaran</creator><creator>Appavu, Brian L.</creator><creator>Buttram, Sandra D.W.</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0009-0007-5409-6633</orcidid><orcidid>https://orcid.org/0000-0002-5396-2559</orcidid></search><sort><creationdate>202406</creationdate><title>Do Racial and Ethnic Disparities Exist in Intensity of Intracranial Pressure–Directed Therapies and Outcomes Following Pediatric Severe Traumatic Brain Injury?</title><author>Schopman, Lauren E. ; Land, Megan E. ; Rakkar, Jaskaran ; Appavu, Brian L. ; Buttram, Sandra D.W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c222t-9119a2b837d3001b521d889e71ed82eae6f0e434555685c5859e8a657bfb499c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adolescent</topic><topic>Black or African American - statistics & numerical data</topic><topic>Brain Injuries, Traumatic - ethnology</topic><topic>Brain Injuries, Traumatic - mortality</topic><topic>Brain Injuries, Traumatic - therapy</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Glasgow Outcome Scale</topic><topic>Healthcare Disparities - ethnology</topic><topic>Healthcare Disparities - statistics & numerical data</topic><topic>Hispanic or Latino - statistics & numerical data</topic><topic>Humans</topic><topic>Infant</topic><topic>Intracranial Pressure - physiology</topic><topic>Male</topic><topic>Treatment Outcome</topic><topic>White People - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schopman, Lauren E.</creatorcontrib><creatorcontrib>Land, Megan E.</creatorcontrib><creatorcontrib>Rakkar, Jaskaran</creatorcontrib><creatorcontrib>Appavu, Brian L.</creatorcontrib><creatorcontrib>Buttram, Sandra D.W.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of child neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schopman, Lauren E.</au><au>Land, Megan E.</au><au>Rakkar, Jaskaran</au><au>Appavu, Brian L.</au><au>Buttram, Sandra D.W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Do Racial and Ethnic Disparities Exist in Intensity of Intracranial Pressure–Directed Therapies and Outcomes Following Pediatric Severe Traumatic Brain Injury?</atitle><jtitle>Journal of child neurology</jtitle><addtitle>J Child Neurol</addtitle><date>2024-06</date><risdate>2024</risdate><volume>39</volume><issue>7-8</issue><spage>275</spage><epage>284</epage><pages>275-284</pages><issn>0883-0738</issn><issn>1708-8283</issn><eissn>1708-8283</eissn><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.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>39246040</pmid><doi>10.1177/08830738241269128</doi><tpages>10</tpages><orcidid>https://orcid.org/0009-0007-5409-6633</orcidid><orcidid>https://orcid.org/0000-0002-5396-2559</orcidid></addata></record> |
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| subjects | Adolescent Black or African American - statistics & numerical data Brain Injuries, Traumatic - ethnology Brain Injuries, Traumatic - mortality Brain Injuries, Traumatic - therapy Child Child, Preschool Ethnicity Female Glasgow Outcome Scale Healthcare Disparities - ethnology Healthcare Disparities - statistics & numerical data Hispanic or Latino - statistics & numerical data Humans Infant Intracranial Pressure - physiology Male Treatment Outcome White People - statistics & numerical data |
| title | Do Racial and Ethnic Disparities Exist in Intensity of Intracranial Pressure–Directed Therapies and Outcomes Following Pediatric Severe Traumatic Brain Injury? |
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