Influence of Insurance Status on Subdural Hematoma Management- An NTDB Analysis

Background: Traumatic brain injury is a major public health concern with a rising inci-dence in the United States. Prior studies have looked at associations between insurance status and traumatic brain injury, but none have focused specifically on traumatic subdural hematomas (SDH). It is important to evaluate whether insurance and/or other social deter-minants of health play a role in treatment and outcomes of traumatic SDH. Methods: A retrospective analysis of the National Trauma Data Bank was conducted from 2012 to 2016 to look at associations between insurance status and management of SDH with surgery versus intracranial pressure (ICP)/EVD monitoring. Secondary outcomes of interest were emergency department (ED) length of stay (LOS), hospital LOS, ICU admission, ICU LOS, and mortality. Results: We identified 68,687 adult patients with a single diagnosis of subdural hematoma. Overall, self-pay patients with SDH were younger, predominately male, and more likely to be non-white compared to patients with public or private health insurance. More specifically, Black/African American SDH patients made up a large percentage of the self-pay category (15.5%; P < 0.001) compared to publicly and privately insured (7.5% and 8.0%, respectively). After adjusting for age, sex, injury severity score (ISS), Glasgow Coma Scale, alcohol intoxica-tion, and trauma center level, publicly insured patients were 1.86 (95% CI 1.36-2.55, P < 0.001) times more likely to undergo a craniotomy or craniectomy compared to self-pay patients. However, insurance status did not appear to impact whether a patient received ICP/EVD monitoring (OR 0.52; 95% CI 0.24-1.18, P = 0.118). There was no statistically significant dif-ference in ED LOS, Hospital LOS, and ICU LOS between insurance categories. Conclusions: Publicly insured patients have higher odds of undergoing surgical management for traumatic SDH compared to self-pay patients. Further studies evaluating this association are warranted. (c) 2021 Elsevier Inc. All rights reserved.

Automated summary

This study analyzed the impact of insurance status on the treatment and outcomes of traumatic brain injury patients, finding that publicly insured patients were more likely to undergo surgical management. However, insurance status did not appear to influence whether patients received intracranial pressure monitoring.