Ethnic and Racial Disparities in Emergency Department Care for Mild Traumatic Brain Injury

Bazarian, Jeffrey J.; Pope, Charlene; McClung, Jason; Cheng, Yen Ting; Flesher, William

doi:10.1111/j.1553-2712.2003.tb00605.x

Cited by 63 publications

(41 citation statements)

References 49 publications

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“…It was initially believed that ethnicity is the main driving force for elevated S100B in African–American subjects [30, 33]. If this were the case, based on available GFR data [12], our model would predict a lower biomarker level in this population due to increased clearance.…”

Section: Resultsmentioning

confidence: 99%

“…Recent literature has demonstrated a clinically relevant difference in serum S100B levels based on race and regional/seasonal variance, where individuals of a darker complexion have been reported to have higher steady-state S100B levels than those of lighter complexion (i.e., Caucasians during summer compared to winter in the Northern hemisphere [32], or individuals of African–American (A–A) compared to Caucasian descent [30, 33]). It was initially believed that ethnicity is the main driving force for elevated S100B in African–American subjects [30, 33].…”

Section: Resultsmentioning

confidence: 99%

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Improving the clinical management of traumatic brain injury through the pharmacokinetic modeling of peripheral blood biomarkers

Dadas

Washington

Marchi

et al. 2016

Fluids Barriers CNS

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BackgroundBlood biomarkers of neurovascular damage are used clinically to diagnose the presence severity or absence of neurological diseases, but data interpretation is confounded by a limited understanding of their dependence on variables other than the disease condition itself. These include half-life in blood, molecular weight, and marker-specific biophysical properties, as well as the effects of glomerular filtration, age, gender, and ethnicity. To study these factors, and to provide a method for markers’ analyses, we developed a kinetic model that allows the integrated interpretation of these properties.MethodsThe pharmacokinetic behaviors of S100B (monomer and homodimer), Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 were modeled using relevant chemical and physical properties; modeling results were validated by comparison with data obtained from healthy subjects or individuals affected by neurological diseases. Brain imaging data were used to model passage of biomarkers across the blood–brain barrier.ResultsOur results show the following: (1) changes in biomarker serum levels due to age or disease progression are accounted for by differences in kidney filtration; (2) a significant change in the brain-to-blood volumetric ratio, which is characteristic of infant and adult development, contributes to variation in blood concentration of biomarkers; (3) the effects of extracranial contribution at steady-state are predicted in our model to be less important than suspected, while the contribution of blood–brain barrier disruption is confirmed as a significant factor in controlling markers’ appearance in blood, where the biomarkers are typically detected; (4) the contribution of skin to the marker S100B blood levels depends on a direct correlation with pigmentation and not ethnicity; the contribution of extracranial sources for other markers requires further investigation.ConclusionsWe developed a multi-compartment, pharmacokinetic model that integrates the biophysical properties of a given brain molecule and predicts its time-dependent concentration in blood, for populations of varying physical and anatomical characteristics. This model emphasizes the importance of the blood–brain barrier as a gatekeeper for markers’ blood appearance and, ultimately, for rational clinical use of peripherally-detected brain protein.Electronic supplementary materialThe online version of this article (doi:10.1186/s12987-016-0045-y) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Improving the clinical management of traumatic brain injury through the pharmacokinetic modeling of peripheral blood biomarkers

Dadas

Washington

Marchi

et al. 2016

Fluids Barriers CNS

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“…23 Studies have found that minorities affected with TBI have different demographic and injury characteristics and poorer functional outcomes than injured non-minorities. 24–28 The discrepancy in functional outcomes has been related to less medical care provided to minorities 26, 28, 29 and to socio-demographic and injury factors. 24, 25, 30 Because minorities and non-minorities afflicted with TBI differ in many aspects, it is necessary that TBI research studies consider an adequate representation of both groups in order to improve the outcomes of the whole population.…”

Section: Discussionmentioning

confidence: 99%

Enrollment of racially/ethnically diverse participants in traumatic brain injury trials: Effect of availability of exception from informed consent

et al. 2014

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Background The Final Rule regulations were developed to allow exception from informed consent (EFIC) to enable clinical trial research in emergency settings where major barriers exist for informed consent. There is little known evidence of the effect of the Final Rule in minority enrollment in clinical trials, particularly in traumatic brain injury (TBI) trials. A clinical trial funded by the National Institute of Neurological Disorders and Stroke was conducted to study the effects of erythropoietin on cerebral vascular dysfunction and anemia in subjects with TBI. There were periods of time when EFIC was and was not available for enrollment into the study. Purpose To explore the effect of EFIC availability on TBI trial enrollment of minority versus non-minority subjects. Methods Minority status of screened (n=289) and enrolled (n=191) TBI subjects was determined for this study. We tested for the presence of a minority and EFIC availability interaction in a multiple logistic regression model after controlling for EFIC and minority group main effects and other covariates. Results An interaction between the availability of EFIC minority and non-minority enrollment was not detected (odds ratio: 1.22; 95% confidence interval: 0.29–5.16). Limitations Our study was conducted at a single site and the confidence interval for the EFIC and minority interaction term was wide. Therefore, a small interaction effect cannot be ruled out. Conclusions EFIC increased the odds of being enrolled regardless of minority status.

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“…Children of Alaska Native ethnicity are over 5 times less likely than children of other ethnicities to be wearing a helmet. This stark disparity in helmet use may explain some of the disparities seen when comparing trauma outcomes between Native and non-Native populations (19,20). Although our data showed a significant difference in prevalence of CNS injury between Native and non-Native children, this difference disappeared when helmet status was taken into account.…”

Section: Discussionmentioning

confidence: 99%

Helmet use among Alaskan children involved in off-road motorized vehicle crashes

Snyder

Muensterer

Sacco

et al. 2014

International Journal of Circumpolar Health

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BackgroundOff-road motorized vehicle crashes are a common source of trauma among Alaska children. Injury morbidity is worse in Alaska Native children than non-Native children, but the reasons are unclear.ObjectiveTo evaluate the differences in helmet use between the Native and the non-Native children, and to assess the impact of helmet use on injury patterns and outcomes.DesignThis retrospective cohort study identified patients aged 17 or younger admitted after all-terrain vehicle, snowmobile or motorbike injury between 2001 and 2011 from the Alaska Trauma Registry. Helmeted and non-helmeted patients were compared with respect to demographics, central nervous system (CNS) injury and the overall risk of death or permanent disability. Logistic regression was used to evaluate predictors of helmet use and the effects of ethnicity and helmet use on outcomes.ResultsOf the 921 injured children, 51% were Alaska Native and 49% were non-Native. Helmet use was lower among Native versus non-Native patients on unadjusted comparison (24% vs. 71%) and multivariable logistic regression (OR 0.17, 95% CI 0.11–0.27, p<0.0001). Prevalence of CNS injury was higher among Native children (39.7% vs. 30.4%, p=0.016). However, on logistic regression with adjustment for helmet use, Native ethnicity was not a significant predictor of CNS injury (OR 1.07, 95% CI 0.68–1.68, p=0.78), whereas helmet use was strongly protective against CNS injury (OR 0.28, 95% CI 0.18–0.44, p<0.0001) as well as death or permanent disability (OR 0.26, 95% CI 0.10–0.67, p=0.006).ConclusionsHelmet use is lower among Alaska Native children involved in off-road motorized vehicle crashes. These ethnic disparities in helmet use contribute to higher rates of CNS injury among Native children. Helmet use significantly improves overall outcome. Helmet promotion efforts should be expanded, especially in Native communities.

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Ethnic and Racial Disparities in Emergency Department Care for Mild Traumatic Brain Injury

Abstract: There are significant racial and ethnic but not gender disparities in ED care for mTBI. The causes of these disparities and the relationship between these disparities and post-mTBI outcome need to be examined.

Cited by 63 publications

References 49 publications

Improving the clinical management of traumatic brain injury through the pharmacokinetic modeling of peripheral blood biomarkers

Improving the clinical management of traumatic brain injury through the pharmacokinetic modeling of peripheral blood biomarkers

Enrollment of racially/ethnically diverse participants in traumatic brain injury trials: Effect of availability of exception from informed consent

Helmet use among Alaskan children involved in off-road motorized vehicle crashes

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