(855) Racial Disparities in Intensity of ICP-Directed Therapies and Outcomes in Pediatric Severe TBI

Introduction: Numerous studies suggest disparities in long-term outcomes in children of racial or ethnic minorities after severe traumatic brain injury (sTBI). In the care of these children, therapies directed to control intracranial pressure (ICP) and cerebral perfusion pressure (CPP) have been shown to correlate with functional outcomes. We aimed to evaluate racial and ethnic disparities in ICP-directed therapies and outcomes after pediatric sTBI.

Methods: We conducted a retrospective cohort analysis using data from the Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial which enrolled sTBI patients ≤18 years old with an ICP monitor from 2014-18. Patients admitted to hospitals outside of the United States were excluded in our analysis to limit regional confounders. ICP-directed therapies evaluated included those from published TBI treatment guidelines. Outcomes were evaluated by assessing mortality and morbidity with an unfavorable outcome defined as Glasgow Outcome Score Extended for Pediatrics (GOS-EP) of 5-8.

Results: 671 ICP-monitored TBI patients (6 [IQR 2-13] y; 64% male; GCS score 5 [IQR 3-7]; GOS-EP score 5 [IQR 3-8]; mortality 20%) were included. Hyperventilation therapy was significantly less used in the “Other” cohort (46%; P = 0.046); no other significant differences in treatment utilization stratified by race/ethnicity. Hispanic ethnicity was associated with lower mortality (OR 0.32 (0.14 - 0.68); P = 0.004) but did not differ in unfavorable outcomes, adjusting for various admission-level features in multivariable logistic modeling. Of note, the non-Hispanic Black cohort was least likely to have GOS-EP data available (69%; P = 0.011).

Conclusions: Utilizing one of the largest national pediatric sTBI databases available to date, our analysis suggests a general lack of disparities in the intensity of ICP-directed therapies and outcomes in children after sTBI stratified by race and ethnicity. Adherence to published guidelines and protocolized care may mitigate individual practice biases. The notable finding of lower mortality in Hispanic patients without a concurrent decrease in unfavorable outcomes merits further investigation. Racial disparities in the availability of outcome measures highlight the critical need for patient-centric rehabilitative interventions and follow-up efforts.