Women with traumatic brain injuries are less likely to be admitted to a trauma centre than men: study

Ambulances sit at the emergency room entrance at the Michael Garron Hospital in Toronto on Thursday, April 29, 2021. THE CANADIAN PRESS/Frank Gunn

A new study has found that women are far less likely to be admitted to a trauma centre for traumatic brain injuries compared to men.

The study, published in the Canadian Medical Association Journal on Monday, analyzed data from more than 55,000 adult patients admitted to Ontario hospitals for traumatic brain injury (TBI). There are 11 lead trauma hospitals across the province, including nine adult centres.

Dr. Natalia Angeloni, an intensive care doctor and co-author of the study, explained TBI is any injury to the brain caused by an external force, whether it be a car accident or a fall to the floor.

Across Canada, based on federal data, there is an average of 21,200 people who are rushed to the hospital for a traumatic brain injury each year. Sixty-three per cent of those hospitalizations were male patients.

“Our study includes all the range of severity from a concussion to a severe traumatic brain injury,” Angeloni told CTV News Toronto in an interview, adding that they only looked at adult patients who were at the hospital for at least two days.

Out of the pool of patients the study analyzed, 21,719 were women, and about a quarter of them (26.1 per cent) were admitted to a lead trauma centre. It pales in comparison to the nearly 40 per cent of men who were admitted for their injuries.

“We had the idea that we were going to find some difference between male and female patients, what I didn’t know that it was going to be so different across different groups,” Angeloni said.

“The data seems to be pretty robust. It’s a really strong signal that females receive different care than males because that difference that we find is after taking into account socioeconomic factors (and) the comorbidities.”

Through all of their analysis, looking into factors like how old the patients are, the severity of their injuries, whether they lived in a city centre or rural area, and whether they had dementia, Angeloni noted the association between women and lower odds of admission to a lead trauma centre was consistent.

Older women with a less severe head injury were even more unlikely to be admitted to a lead trauma centre, according to the findings. The study also found female patients were generally older, with a median age of 78, and were more likely to suffer from a pre-existing health condition, while men were more likely to suffer from a severe trauma.

Diagnosis is critical

Accurate diagnosis is vital because it sets up the kind of treatment and care that patient receives, according to Karen Soldatic, the Canada Excellence Research Chair in Health Equity and Community at Toronto Metropolitan University.

“For women in particular, who have the highest rates of violence-related acquired brain injury associated with gender-based violence, this is particularly critical in terms of the kinds of access to services and the types of return to life that they can practice at the point of not just clinical diagnosis, but the end of the immediate treatment regime,” Soldatic said in an interview with CTV News Toronto.

“Diagnosis is critical to setting up appropriate pathways for lifelong care, not just for the individual, but the network in which they’re embedded.”

The study did not compare what caused individual patients’ injuries and it did not look into the causes for the disparities between men and women (or analyze the impacts of those outcomes).

The research did, however, note how unconscious sex-related bias could play a factor.

In triage, difficult decisions are made quickly—something Angeloni acknowledges.

“There are decisions that have to be done quickly and with incomplete information. There are sometimes people in the triage field, they have to assume things, and that is why we think that unconscious sex bias can play a role,” Angeloni said, adding that female injuries tend to be underestimated.

“Another role that can be there is some differences in presentation in male and female that we could not measure, because this is an observational study.”

The new study also notes how an underrepresentation of female patients with trauma and TBI in research studies could also lead to a limited understanding of what symptoms to look out for.

Dr. Nancy Walton, an associate professor of nursing at Toronto Metropolitan University, explains how there are formal guidelines and assessments utilized for sending patients from a hospital to a trauma centre—but that criteria may be based on research that focused on male patients.

“When we look at how health-care providers approach patients in pain, they can approach men and women differently,” Walton said, noting how men and women present differently when they are in acute pain.

“The last thing the (study) talk(s) about is that women, not always, but tend to present with a traumatic brain injury caused by less dramatic or a less violent cause, so a fall in this study.”

While the study reveals female patients are less frequently getting admitted to trauma centres, it does not outline the quality of care that they receive.

Soldatic and Walton applaud the study and say it should be taken seriously, but acknowledge further research needs to be done—particularly studies that are co-designed with women and at-risk communities in mind.

Angeloni says their next step is to research the outcomes for male and female patients.

“For the ones that go to the ICU, go to a trauma centre, to see if this difference in interventions affects the outcomes,” Angeloni said.