Chequer de Souza, Julia, Dobson, Geoffrey P., Lee, Celine J., and Letson, Hayley L. (2024) Epidemiology and outcomes of brain trauma in rural and urban populations: a systematic review and meta-analysis. Brain Injury. (In Press)

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Abstract

Objective: To identify and describe differences in demographics, injury characteristics, and outcomes between rural and urban patients suffering brain injury.

Data Sources: CINAHL, Emcare, MEDLINE, and Scopus.

Review Methods: A systematic review and meta-analysis of studies comparing epidemiology and outcomes of rural and urban brain trauma was conducted in accordance with PRISMA and MOOSE guidelines.

Results: 36 studies with ~ 2.5-million patients were included. Incidence of brain injury was higher in males, regardless of location. Rates of transport-related brain injuries, particularly involving motorized vehicles other than cars, were significantly higher in rural populations (OR:3.63, 95% CI[1.58,8.35], p = 0.002), whereas urban residents had more fall-induced brain trauma (OR:0.73, 95% CI[0.66,0.81], p < 0.00001). Rural patients were 28% more likely to suffer severe injury, indicated by Glasgow Coma Scale (GCS)≤8 (OR:1.28, 95% CI[1.04,1.58], p = 0.02). There was no difference in mortality (OR:1.09, 95% CI[0.73,1.61], p = 0.067), however, urban patients were twice as likely to be discharged with a good outcome (OR:0.52, 95% CI[0.41,0.67], p < 0.00001).

Conclusions: Rurality is associated with greater severity and poorer outcomes of traumatic brain injury. Transport accidents disproportionally affect those traveling on rural roads. Future research recommendations include addition of prehospital data, adequate follow-up, standardized measures, and sub-group analyses of high-risk groups, e.g. Indigenous populations.

Item ID:	82949
Item Type:	Article (Research - C1)
ISSN:	1362-301X
Keywords:	Trauma; brain; injury; rural; urban
Copyright Information:	© 2024 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/),which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
Date Deposited:	10 Jun 2024 23:39
FoR Codes:	32 BIOMEDICAL AND CLINICAL SCIENCES > 3209 Neurosciences > 320903 Central nervous system @ 30% 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320207 Emergency medicine @ 50% 42 HEALTH SCIENCES > 4202 Epidemiology > 420299 Epidemiology not elsewhere classified @ 20%
SEO Codes:	20 HEALTH > 2004 Public health (excl. specific population health) > 200408 Injury prevention and control @ 50% 20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200508 Rural and remote area health @ 50%
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