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Peer-reviewedCC BYThe western journal of emergency medicine

Rural-Urban Parity and Socioeconomic Gaps in Traumatic Brain Injury Outcomes.

  • Minahil Cheema1
  • Aamna Cheema1,2
  • Anastasia Ternovskaia1,2
  • Raneem Hamada Megahed3
  • Patrick McGinnis1
  • Japneet Sarai2
  • Taylor Kowansky2
  • Shriya Jaddu2
  • Emily Esposito4,5
  • Jessica V Downing4,5
  • Quincy K Tran2,4,5
5 affiliations
  1. 1University of Maryland School of Medicine, Baltimore, Maryland.
  2. 2University of Maryland School of Medicine, Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, Baltimore, Maryland.
  3. 3George Washington University, School of Medicine and Health Sciences, Washington, DC.
  4. 4University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
  5. 5University of Maryland School of Medicine, Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland.
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Abstract

Background

Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Rural residence and low community income are independently associated with poorer health outcomes, mediated by variations in injury mechanism and healthcare access. We evaluated the impact of geographic location on injury patterns and acute-care metrics in adults with TBI treated at Maryland's statewide Level I trauma center.Methods

Adults (≥18 years of age) with radiographically confirmed TBI admitted between 2017 and 2021 were identified retrospectively from the institutional trauma registry. Rural residence was defined using Rural-Urban Commuting Area codes. This single-center study included only patients surviving to hospital admission. Primary outcomes included hospital length of stay (LOS) and discharge to hospice or death. Secondary outcomes included intensive care unit (ICU) and ventilator days and discharge disposition.Results

Of 2,812 patients diagnosed with TBI during the study period, 267 (9.5%) resided in rural areas. Compared with nonrural patients, rural patients were older (median age 67 vs 60 years, P < .001) and lived in lower income communities. However, after adjustment for demographic and clinical covariates, rural residence was not associated with higher hospital LOS quartile category (adjusted odds ratio [aOR] 1.18; 95% CI, 0.91-1.53; P = .20), discharge to hospice or death (aOR 1.67; 95% CI, 0.95-2.94), or discharge to a nonhome setting (aOR 0.93; 95% CI, 0.66-1.31). Groups showed no significant differences in critical care use, including ICU and ventilator durations. Worse outcomes were associated primarily with injury severity, including lower Glasgow Coma Scale scores and higher Injury Severity Scores.Conclusion

In a well-established regional trauma network, we found that among patients admitted with traumatic brain injury, residing in a rural area was not independently associated with worse in-hospital outcomes compared to patients who resided in nonrural (urban and suburban) communities. These findings suggest that a coordinated statewide trauma triage and access to tertiary neurotrauma care may help other systems similarly reduce rural disparities after severe head injury.

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Cite

BibTeXRIS
BibTeX
@article{cheema2026ruralurban,
  title = {{Rural-Urban Parity and Socioeconomic Gaps in Traumatic Brain Injury Outcomes.}},
  author = {Minahil Cheema and Aamna Cheema and Anastasia Ternovskaia and Raneem Hamada Megahed and Patrick McGinnis and Japneet Sarai and Taylor Kowansky and Shriya Jaddu and Emily Esposito and Jessica V Downing and Quincy K Tran},
  journal = {The western journal of emergency medicine},
  year = {2026},
  month = sep,
  doi = {10.5811/westjem.62017},
  url = {https://europepmc.org/article/MED/42900938},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Rural-Urban Parity and Socioeconomic Gaps in Traumatic Brain Injury Outcomes.
AU  - Minahil Cheema
AU  - Aamna Cheema
AU  - Anastasia Ternovskaia
AU  - Raneem Hamada Megahed
AU  - Patrick McGinnis
AU  - Japneet Sarai
AU  - Taylor Kowansky
AU  - Shriya Jaddu
AU  - Emily Esposito
AU  - Jessica V Downing
AU  - Quincy K Tran
PY  - 2026
DA  - 2026/09/05
JO  - The western journal of emergency medicine
DO  - 10.5811/westjem.62017
UR  - https://europepmc.org/article/MED/42900938
AB  - Background  Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Rural residence and low community income are independently associated with poorer health outcomes, mediated by variations in injury mechanism and healthcare access. We evaluated the impact of geographic location on injury patterns and acute-care metrics in adults with TBI treated at Maryland's statewide Level I trauma center.Methods  Adults (≥18 years of age) with radiographically confirmed TBI admitted between 2017 and 2021 were identified retrospectively from the institutional trauma registry. Rural residence was defined using Rural-Urban Commuting Area codes. This single-center study included only patients surviving to hospital admission. Primary outcomes included hospital length of stay (LOS) and discharge to hospice or death. Secondary outcomes included intensive care unit (ICU) and ventilator days and discharge disposition.Results  Of 2,812 patients diagnosed with TBI during the study period, 267 (9.5%) resided in rural areas. Compared with nonrural patients, rural patients were older (median age 67 vs 60 years, P < .001) and lived in lower income communities. However, after adjustment for demographic and clinical covariates, rural residence was not associated with higher hospital LOS quartile category (adjusted odds ratio [aOR] 1.18; 95% CI, 0.91-1.53; P = .20), discharge to hospice or death (aOR 1.67; 95% CI, 0.95-2.94), or discharge to a nonhome setting (aOR 0.93; 95% CI, 0.66-1.31). Groups showed no significant differences in critical care use, including ICU and ventilator durations. Worse outcomes were associated primarily with injury severity, including lower Glasgow Coma Scale scores and higher Injury Severity Scores.Conclusion  In a well-established regional trauma network, we found that among patients admitted with traumatic brain injury, residing in a rural area was not independently associated with worse in-hospital outcomes compared to patients who resided in nonrural (urban and suburban) communities. These findings suggest that a coordinated statewide trauma triage and access to tertiary neurotrauma care may help other systems similarly reduce rural disparities after severe head injury.
SN  - 1936-900X
SN  - 1936-9018
ER  -