A new Canadian study published in the Canadian Medical Association Journal reveals that women hospitalized with traumatic brain injuries (TBI) are significantly less likely than men to be admitted to Level I or II trauma centres—hospitals specially equipped to treat severe injuries.
Key Findings on Gender Disparity
Researchers analyzed more than 55,000 adults hospitalized with TBIs in Ontario. Overall, just over one in four women (26.1%) were admitted to a lead trauma centre, compared with nearly four in ten men (38.3%). After adjusting for factors such as age, injury severity, existing health conditions, income, and rural or urban residence, the gap narrowed to about 4.7 percentage points. However, researchers emphasize that this difference remains meaningful across thousands of patients.
Dr. Tatyana Mollayeva, a scientist at UHN’s KITE Research Institute and lead author of the study, stated, “Traumatic brain injury is a serious condition that can have lifelong consequences… Across a large population, even small differences in referral and admission patterns can translate into a substantial number of patients who may not receive specialized trauma care.”
Possible Explanations for the Gap
The study found that women and men in the cohort differed medically. Women were generally older, had more chronic health conditions, and were less likely to have severe brain injuries. Men were more likely to have major trauma, require intensive care, and have substance abuse issues—factors that can indicate greater instability when first assessed by emergency responders.
Researchers lacked important data that can influence transfer decisions, including Glasgow Coma Scale scores, neurological exams, vital signs, hospital capacity, transfer suitability, and patients' wishes. Without these details, the study cannot pinpoint the exact cause of the disparity.
One possible explanation raised is unconscious bias. Dr. Mollayeva noted, “Unconscious bias is one possible explanation, but it should be considered alongside other clinical and knowledge system-level factors.” She added that women with brain injuries may not fit the traditional profile of severe trauma patients, as much research has historically focused on men injured in car crashes, military settings, or workplace accidents.
Historical Research Gaps
Older women often suffer brain injuries from ground-level falls and may have frailty, dementia, multiple chronic illnesses, or take medications that complicate assessment. Their symptoms can overlap with other conditions, making serious brain injuries easier to overlook. “If the presentation does not match our existing knowledge of the ‘average’ severe trauma patient,” Dr. Mollayeva said, “TBI in females can be overlooked or underestimated.”
The disparity persisted across several subgroups, including younger and older patients, those with more and less severe injuries, rural and urban residents, and patients with dementia.
Next Steps for Research
Dr. Mollayeva emphasizes that future studies should combine hospital records with ambulance reports, emergency department data, and trauma registry information to better understand how transfer decisions are made. Researchers should also examine whether referral patterns changed between 2009 and 2020, when Ontario introduced new trauma network guidance.
“If the difference narrowed… that may suggest improvement in referral pathways,” Dr. Mollayeva said. “If it remained stable, it may indicate a persistent pattern. And if it widened, it would raise new questions about the quality of evidence, system changes or access to trauma care.”
