Ontario Data Show Women With TBI Admitted to Trauma Centers at 26% Lower Rate Than Men

The ICES-linked analysis examined all adults hospitalized for traumatic brain injury across Ontario. Women comprised 39% of cases yet only 30% of trauma-center admissions. Median female age was 78 versus 67 for men; women more often presented after ground-level falls and carried higher dementia and hypertension burdens, while men showed higher rates of severe head injury. Prehospital triage protocols that prioritize high-energy mechanisms therefore systematically under-flagged female patients.

This disparity aligns with documented patterns in acute cardiovascular and stroke care where implicit bias and atypical symptom presentation delay specialist referral. The study authors note both lower-energy mechanisms and unconscious sex-related bias as plausible drivers; the smaller female enrollment in prior TBI trials has left guideline developers without sex-stratified severity thresholds. Ontario already exhibits high overtriage and undertriage rates, amplifying the scope for discretionary decisions.

Targeted interventions shown effective in other domains—sex-specific triage checklists, bias training with audit feedback, and mandatory review of all moderate TBI cases denied trauma-center transfer—remain untested here. Without such steps the mortality and disability gap will persist.