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Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations

Introduction: Traumatic brain injury (TBI) remains a primary cause of pediatric morbidity. The improved characterization of healthcare disparities for pediatric TBI in United States (U.S.) rural communities is needed to advance care. Methods: The PubMed database was queried using keywords ((“brain/h...

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Autores principales: Yue, John K., Upadhyayula, Pavan S., Avalos, Lauro N., Cage, Tene A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139684/
https://www.ncbi.nlm.nih.gov/pubmed/32121176
http://dx.doi.org/10.3390/brainsci10030135
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author Yue, John K.
Upadhyayula, Pavan S.
Avalos, Lauro N.
Cage, Tene A.
author_facet Yue, John K.
Upadhyayula, Pavan S.
Avalos, Lauro N.
Cage, Tene A.
author_sort Yue, John K.
collection PubMed
description Introduction: Traumatic brain injury (TBI) remains a primary cause of pediatric morbidity. The improved characterization of healthcare disparities for pediatric TBI in United States (U.S.) rural communities is needed to advance care. Methods: The PubMed database was queried using keywords ((“brain/head trauma” OR “brain/head injury”) AND “rural/underserved” AND “pediatric/child”). All qualifying articles focusing on rural pediatric TBI, including the subtopics epidemiology (N = 3), intervention/healthcare cost (N = 6), and prevention (N = 1), were reviewed. Results: Rural pediatric TBIs were more likely to have increased trauma and head injury severity, with higher-velocity mechanisms (e.g., motor vehicle collisions). Rural patients were at risk of delays in care due to protracted transport times, inclement weather, and mis-triage to non-trauma centers. They were also more likely than urban patients to be unnecessarily transferred to another hospital, incurring greater costs. In general, rural centers had decreased access to mental health and/or specialist care, while the average healthcare costs were greater. Prevention efforts, such as mandating bicycle helmet use through education by the police department, showed improved compliance in children aged 5–12 years. Conclusions: U.S. rural pediatric patients are at higher risk of dangerous injury mechanisms, trauma severity, and TBI severity compared to urban. The barriers to care include protracted transport times, transfer to less-resourced centers, increased healthcare costs, missing data, and decreased access to mental health and/or specialty care during hospitalization and follow-up. Preventative efforts can be successful and will require an improved multidisciplinary awareness and education.
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spelling pubmed-71396842020-04-10 Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations Yue, John K. Upadhyayula, Pavan S. Avalos, Lauro N. Cage, Tene A. Brain Sci Review Introduction: Traumatic brain injury (TBI) remains a primary cause of pediatric morbidity. The improved characterization of healthcare disparities for pediatric TBI in United States (U.S.) rural communities is needed to advance care. Methods: The PubMed database was queried using keywords ((“brain/head trauma” OR “brain/head injury”) AND “rural/underserved” AND “pediatric/child”). All qualifying articles focusing on rural pediatric TBI, including the subtopics epidemiology (N = 3), intervention/healthcare cost (N = 6), and prevention (N = 1), were reviewed. Results: Rural pediatric TBIs were more likely to have increased trauma and head injury severity, with higher-velocity mechanisms (e.g., motor vehicle collisions). Rural patients were at risk of delays in care due to protracted transport times, inclement weather, and mis-triage to non-trauma centers. They were also more likely than urban patients to be unnecessarily transferred to another hospital, incurring greater costs. In general, rural centers had decreased access to mental health and/or specialist care, while the average healthcare costs were greater. Prevention efforts, such as mandating bicycle helmet use through education by the police department, showed improved compliance in children aged 5–12 years. Conclusions: U.S. rural pediatric patients are at higher risk of dangerous injury mechanisms, trauma severity, and TBI severity compared to urban. The barriers to care include protracted transport times, transfer to less-resourced centers, increased healthcare costs, missing data, and decreased access to mental health and/or specialty care during hospitalization and follow-up. Preventative efforts can be successful and will require an improved multidisciplinary awareness and education. MDPI 2020-02-28 /pmc/articles/PMC7139684/ /pubmed/32121176 http://dx.doi.org/10.3390/brainsci10030135 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Yue, John K.
Upadhyayula, Pavan S.
Avalos, Lauro N.
Cage, Tene A.
Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations
title Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations
title_full Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations
title_fullStr Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations
title_full_unstemmed Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations
title_short Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations
title_sort pediatric traumatic brain injury in the united states: rural-urban disparities and considerations
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139684/
https://www.ncbi.nlm.nih.gov/pubmed/32121176
http://dx.doi.org/10.3390/brainsci10030135
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