Ethnic disparities in long-term functional outcomes after traumatic brain injury

Objectives: Ethnic disparities in access to acute rehabilitation and in long-term global neurologic outcomes after traumatic brain injury (TBI) have been previously documented. The current study was undertaken to determine whether there are specific types of functional deficits that disproportionately affect ethnic minorities after TBI. Methods: The TBI Clinical Trials Network is a National Institutes of Health-funded multicenter prospective study. Local data from trauma centers in a single ethnically diverse major metropolitan study site were analyzed. Functional outcomes were measured in 211 patients with blunt TBI (head Abbreviated Injury Scale score 3-5) who were alive ≥6 months after discharge using the Functional Status Examination (FSE), which measures outcome in 10 functional domains and compares current functional status to preinjury status. For each domain, patients were classified as functionally independent (FSE score 1, 2) or dependent upon others (FSE score 3, 4). Ethnic minorities (n = 66) were compared with non-Hispanic whites (n = 145), with p < 0.05 considered significant. Results: The two groups had similar injury severity (head Abbreviated Injury Scale score, initial Glasgow Coma Scale score, Injury Severity Score) and were equally likely to be placed in rehabilitation after trauma center discharge (minorities 51%, whites 46%, p = 0.28). Minority patients experienced worse long-term functional outcomes in all domains, which reached statistical significance in post-TBI standard of living, engagement in leisure activities, and return to work or school. Conclusions: Ethnic minorities with TBI suffer worse long-term deficits in three specific functional domains. TBI rehabilitation programs should target these specific areas to reduce disparities in functional outcomes in ethnic minorities.