1022 Measuring Success in Distance Traveled: Examining the Unique Obstacles of Indigenous American Patients With Acute Neurosurgical Injuries

INTRODUCTION: Historically, Indigenous American (IA) populations have faced barriers to adequate healthcare. Although IA people experience higher rates of traumatic brain injury (TBI)-related mortality than other racial groups in the US, attributes of their neurosurgical care have not been evaluated. METHODS: Adults hospitalized for acute neurosurgical injuries in 2017-2022 were identified in this retrospective cross-sectional study at our Level 1 trauma center. We evaluated demographics, distance to care, and in-hospital/aftercare characteristics in a propensity-matched analysis. RESULTS: Eighty-four IA patients were identified upon admission to neurointensive care. Propensity score analysis matched 77 IA and 77 non-IA patients with similar inclusion criteria on demographics, medical comorbidities, and distance traveled to neurosurgical care. IA patients traveled longer distances for care (236.3 vs. 146.4 miles, p<.001), were more often direct admissions (35.1% vs. 0.0%), were more often transported via ambulance (72.7% vs. 57.1%) and less often via helicopter (20.8% vs. 41.6%), and came from a broader cross-section of states. Average time from injury to care was 6 hours (IQR 3.0, 9.4). In-hospital care did not differ between groups; however, IA patients were less often discharged to rehabilitation (2.6% vs. 14.3%, p=.009). IA in-hospital TBI-related mortality was 8.3%. Fewer follow-up visits were completed in IA than non-IA patients (40.2% vs. 90.0%, p<.001), despite more attempted contacts (66.7% vs. 30.6%, p<.001), with low telemedicine use in both groups (2.7% vs. 5.5%). IA status and distance traveled for care were independent predictors of unmet follow-up visits (OR 6.22 [95%CI 1.49-25.99, p=.012] and OR 12.34 [95%CI 1.19-127.99, p=.035], respectively). CONCLUSIONS: Clear barriers to care were demonstrated for IA patients with acute neurosurgical injuries. Our findings indicate improvements are needed for this vulnerable population.