Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University



Traumatic brain injury (TBI) greatly contributes to morbidity and mortality in the pediatric population. Outcomes of TBI may vary geographically. We examined potential urban/rural disparities in mortality amongst Oregon pediatric TBI patients treated in trauma hospitals.


Oregon pediatric patients, ages 0-19, seen in trauma hospitals for TBI were identified from the Oregon Trauma Registry for years 2009-2012. Location of injury was classified using the National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme. Severity of overall trauma was estimated using Injury Severity Scores (ISS) and type of TBI was categorized as blunt versus penetrating injury. Incidence rates were calculated using Census data for denominators. Associations between urban/rural injury location and mortality were assessed using multivariable logistic regression, controlling for potential confounders. Generalized estimating equations were used to help account for clustering of data within hospitals.


Of 2,794 pediatric TBI patients, 46.6% were injured in large metropolitan locations, 24.8% in medium/small metropolitan locations, and 28.6% in non-metropolitan locations. Children from non-metropolitan (rural) locations had the greatest annualized incidence rate of TBI, at 107/100,000 children per year, and also tended to have higher ISS scores than those from large metropolitan areas (71/100,000 per year). Without adjustment for other factors, non-metropolitan location of injury was associated with increased odds of mortality (odds ratio [OR]=2.51; 95% CI= 1.57-4.03). This association remained significant while adjusting for age, gender, race/ethnicity, insurance status, ISS, and TBI type (OR=1.91; 95% CI=1.11-3.30).


This study identified a greater incidence rate of TBI and a higher proportion of severe injury in rural areas compared to urban areas in Oregon. Rural children treated in the trauma system for TBI were more likely to die than urban children after controlling for overall trauma severity and other factors associated with urban/rural residence. Research is needed to examine treatment and care disparities between urban and rural children. Future work should also identify interventions that can reduce risk of TBI and TBI-related mortality among children, particularly those who live in rural areas.




School of Medicine



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