Children in rural areas experience barriers to care for traumatic brain injury

Child Being Cared for in Hospital

Traumatic brain injury (TBI) is a leading cause of death and injury among children in the United States. Although recent advances in health care have significantly improved children’s survival and post-injury outcomes, many children in the United States experience challenges that may prevent them from accessing high-quality TBI care. Evidence suggests that children from marginalized racial and ethnic groups and children living in low-resource areas are most likely to encounter barriers to pediatric health care. Before health care providers can begin to address these disparities, they need to understand the specific factors that may limit families’ access to pediatric TBI supports and services.

A recent review of pediatric literature investigated disparities between rural and urban families’ access to trauma care for children who sustained TBI. A research team reviewed 10 high-quality studies of pediatric TBI in the United States, limited to studies that discussed TBI care among children living in rural or underserved areas. After reviewing the results of each study, they found that:

  • Compared to children from urban areas, children from rural areas were more likely to have severe TBI and were more often injured from high-velocity car accidents.
  • Rural patients often experienced delayed care as a result of long transport times, bad weather, and lack of nearby hospitals equipped to address severe head injuries.
  • Patients who attended rural hospitals generally had higher health care costs, even though rural hospitals provided less access to mental health and specialist care services.

Children living in rural areas face significant barriers to accessing quality TBI care. Because most trauma centers are located near urban areas, many rural children experience long delays between injury and hospital admission. Additionally, local rural hospitals often lack specialty services—including mental health care—that are known to improve pediatric outcomes and quality of life after injury. As a result, rural children who survive TBI face significant challenges during the weeks, months, or years following the initial injury.

Health care providers and policy makers can address these systemic issues by collaborating towards actionable changes for care delivery. Stakeholders must work together to decrease disparities in health care access among underserved populations, including children from rural areas.

Yue JK, Upadhyayula PS, Avalos LN, & Cage TA. Pediatric traumatic brain injury in the United States: Rural-urban disparities and considerations. Brain Sciences. (February 2020).

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