(1357) Examining Disparities in Traumatic Brain Injury Outcomes: Impact of Rurality & Socioeconomic Factors

Introduction: The Shock Trauma Center at the University of Maryland Medical Center (UMMC) receives a diverse patient population from Maryland, yet rural patients remain a minority, making it challenging to detect differences in traumatic brain injury (TBI) patterns and outcomes. TBI is a leading cause of morbidity and mortality worldwide, with worse outcomes for rural patients due to potential barriers such as delayed access to care and limited healthcare resources. This study investigates the impact of social determinants of health (SDoH), including occupation, median zip code income, and rural status (Health Professional Shortage Area [HPSA] or Medically Underserved Area [MUA]), on TBI injury types. We hypothesized that patients from rural zip codes would have different patterns of injury and worse outcomes compared to their non-rural counterparts.

Methods: This retrospective observational study analyzed adult patients with TBI at UMMC from 2016 to 2023. Rural areas were defined according to state statute, and outcomes were compared between groups such as length of stay (LOS), ICU days, and discharge disposition. Chi-square tests and t-tests were used to identify significant differences.

Results: We examined data from 3083 patients, of whom 267 were rural and 2545 non-rural. Subdural hematoma (SDH), the most common type of injury in the population, was significantly less prevalent among rural patients (116/195, 59%) compared to non-rural patients (1719/2545, 68%, p=0.021). Other brain injury types showed no significant differences between rural and non-rural patients. No significant differences were found in LOS or ICU days between the groups.

Conclusions: The study highlights a significant difference in SDH prevalence between rural and non-rural TBI patients, despite the overall low number of rural cases. Future research, including a larger sample size with rural patients, is needed to better understand the impact of SDoH on TBI outcomes and inform targeted interventions to improve care for rural populations.