Race\ethnicity and outcome after traumatic brain injury at a single, diverse center.
BACKGROUND
Many factors may predict mortality and disability after traumatic brain injury (TBI), including age and injury severity. However, the role of race\ethnicity has typically been studied tangentially or in homogeneous settings. We investigated whether race\ethnicity was associated with medical outcomes at a single, diverse center.


METHODS
We retrospectively identified patients with TBI older than 17 years with blunt injuries admitted to a Level I trauma center from 2001 to 2004. Glasgow Outcome Scale (GOS) was used to determine outcome at discharge. We performed multivariable logistic regression on two measures of outcome by dichotomizing Glasgow Outcome Scale scores.


RESULTS
We identified 357 patients with TBI from five categories: whites (46.2%), Asians (19.9%), Hispanics (17.9%), blacks (10.9%), and other\unknown (5.0%). Without adjusting for other factors, Asians experienced higher mortality (odds ratio [OR] = 2.25, p = 0.01) compared with whites but not degree of disability. After adjusting for age and Injury Severity Score, a weaker trend remained for higher mortality in Asians (OR = 1.38, p = 0.35), and after excluding cases of assault, the finding was again significant (OR = 2.00, p = 0.04). We also confirmed the recently reported OR of higher mortality among blacks (OR = 1.30). Hispanics seemed to do slightly better at discharge.


CONCLUSIONS
The question of whether and how race plays a role in TBI is controversial. At a single, diverse center, we found that mortality is associated with race, age, and Injury Severity Score. Future clinical studies will benefit from detailed genotypic and phenotypic data and should balance larger sample sizes with ethnic diversity.
Sorani
Marco D
MD
Program in Biological and Medical Informatics, University of California, San Francisco, California 94110, USA.
Lee
Michaela
M
Kim
Helen
H
Meeker
Michele
M
Manley
Geoffrey T
GT
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001930:Brain Injuries / Q000208:ethnology* / Q000401:mortality / Q000534:rehabilitation; D002140:California / Q000453:epidemiology; D018864:Cultural Diversity; D004185:Disability Evaluation; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult