2122 Higher Rates of Neurosurgical Interventions in Black Pediatric Patients Following Traumatic Brain Injury

INTRODUCTION: Racial disparities in healthcare outcomes have been widely documented in the literature. Black pediatric patients continue to face disproportionate challenges related to traumatic brain injuries (TBI) based on their race, socioeconomic status, access to healthcare, and implicit biases within the healthcare system. Looking specifically at the relationship between neurosurgical intervention, race, and TBI severity together has not yet been studied in the present literature. METHODS: Prospective cohort of patients 0-20 years-old presenting to a tertiary pediatric hospital emergency department from May 2018 to January 2021 with TBI were analyzed in this study (n=354). Intracranial pressure (ICP) monitors, external ventricular drains (EVD), and/or craniotomies/craniectomies were considered as having neurosurgical interventions (n=55). Variables including race/ethnicity were obtained from parents and electronic medical records. TBI severity was assigned based on lowest Glasgow Coma Scale score. Chi-Square tests were utilized. RESULTS: There was a significant association between race and neurosurgical intervention (χ2 (1) = 10.075, p=0.002), such that Black patients had higher rates of neurosurgical intervention (22.9%) compared to White (10.5%). Severity also correlated with neurosurgical intervention, such that 55.4% of severe TBI patients received neurosurgery compared to 5% of moderate/mild TBI patients (p<0.001). Race and severity were associated (χ2 (1) = 15.715, p<0.001), such that 31.3% of Black patients had severe TBI compared to 13.8% of White patients. CONCLUSIONS: Overall Black patients had more severe TBI and thus higher rates of neurosurgical intervention. Future studies should investigate why these rates are seen in Black patients, considering mechanisms of injury and the influence of social determinants of health on outcomes.