UC Davis

Background: Traumatic brain injuries (TBIs) represent a significant global health burden, affecting millions of individuals annually and leading to substantial morbidity, mortality, and healthcare costs worldwide. These injuries, caused by sudden trauma to the brain, are associated with disparities in prevalence based on factors such as gender, race/ethnicity, military service, intimate partner violence, and poverty. Despite their increasing prevalence and devastating consequences, including long-term physical, cognitive, and emotional impairments, research progress and funding for TBIs have been limited, prompting calls to address this "silent epidemic" through concerted efforts in prevention, clinical care, and research. Despite the growing research on TBIs, notable gaps within the literature include the lack of studies on adults aged 18–64, gender disparities in clinical trial recruitment and outcomes, limited literature on the mechanisms of injury and TBI severity levels, and insufficient focus on moderate TBIs, which are often combined with mild or severe categories despite their significant consequences. These gaps demonstrate the need for more comprehensive and targeted research in these areas.Methods: This cross-sectional analysis uses data from the National Trauma Data Bank (NTDB) and includes data from 747 trauma designated hospitals nationwide. For the first aim, we used multinomial logistic regression to examine associations between mechanism of injury (MOI) and TBI severity. In the second aim, we focused on individuals with moderate TBI, using multinomial logistic regression to understand associations between MOI and discharge disposition and survival modeling to understand associations between MOI and hospital length of stay. To determine the influence of each independent variable more precisely, both studies accounted for relevant sociodemographic factors and health-related covariates. Results: Aim 1 analysis finds that transportation-related TBIs are the most common MOI across all TBI severities and sexes, underscoring the urgency for targeted prevention strategies. Additionally, our findings highlight disparities notably indicating lower rates of severe TBI cases treated at level I trauma centers and larger hospitals, highlighting potential barriers to optimal trauma care access for individuals with higher TBI severities. Aim 2 analysis concludes that there are significant associations between MOI and discharge disposition; transportation-related moderate TBIs are most likely to be discharged to inpatient rehabilitation, SNF, or long term-care compared to home or home with home-health. Similarly, there is an association between increased hospital LOS and transportation-related moderate TBIs compared to other MOIs. Conclusion: Collectively, these findings underscore the substantial burden of transportation-related TBIs and the need for targeted prevention strategies to mitigate this public health crisis. Moreover, the disparities identified in access to optimal trauma care and discharge dispositions for individuals with severe TBIs highlight the urgency for addressing systemic barriers and inequities in the healthcare system. Concerted efforts involving multidisciplinary collaborations, increased research funding, and evidence-based policies are crucial to combat this "silent epidemic" and improve outcomes for individuals affected by TBIs.