Female TBI Patients 26% Less Likely to Be Admitted to Specialized Trauma Centres, Ontario Study Finds
Key Insights
A population-based study of 55,606 Ontario patients found female TBI patients were 26% less likely to be admitted to specialized trauma centres than males, even after adjusting for age, injury severity, and comorbidities.
Female patients were older (median age 78 vs. 67), more often injured by low-energy falls, and had lower rates of severe head trauma (25% vs. 33%) compared to males.
Researchers suggest unconscious sex-related bias and lower prehospital priority for low-energy mechanisms may contribute to the disparity in triage and admission.
A large population-based cohort study from Ontario has revealed a significant sex-based disparity in trauma care: female patients with traumatic brain injury (search) (TBI) are 26% less likely to be admitted to a specialized trauma centre than their male counterparts. The findings, published June 15, 2026 in the Canadian Medical Association Journal (CMAJ), persisted even after researchers accounted for age, injury severity, comorbid health conditions, and socioeconomic circumstances.
The study analyzed ICES data encompassing 55,606 patients admitted to hospital for TBI in Ontario between April 2009 and March 2020. Of these, 39% (21,719) were female. Among the 18,650 patients admitted to a specialized trauma centre, only 26% (5,666) of female patients received such admission, compared to 38% (12,984) of male patients.
Striking demographic and clinical differences
The study uncovered notable demographic and clinical distinctions between female and male TBI patients. Female patients were considerably older, with a median age of 78 years compared to 67 years for males, and were more likely to have dementia (search) and hypertension (search). Male patients, by contrast, presented with higher rates of severe head trauma — 33% versus 25% among females.
Mechanisms behind the disparity
Dr. Natalia Angeloni, a critical care physician at Sunnybrook Health Sciences Centre and PhD student at the University of Toronto, and coauthors identified several factors that may contribute to the variation in admission rates.
"First, injuries in female patients are more often associated with lower-energy mechanisms, such as ground-level falls, that may attract less attention and may lead to lower prehospital priority," the authors write. "Second, unconscious (implicit) sex-related bias may contribute to differential recognition of severity of injury."
The researchers also noted that smaller numbers of female patients with TBI in research studies may contribute to a narrow understanding of how trauma presents in females, potentially compounding the problem.
Triage performance under scrutiny
The study highlights broader concerns about trauma triage in Ontario. "In Ontario, triage performance is suboptimal, with high rates of both overtriage and undertriage, suggesting variability in decision-making, even when standardized guidelines are in place," the authors state.
They emphasize that understanding how this variability interacts with sex and gender is critical. "The role, if any, of conscious and unconscious bias in clinical decision-making in care of patients with TBI should be explored, as has been done for other clinical conditions; results should guide targeted interventions to reduce the disparities we have identified."
Traumatic brain injuries, often resulting from falls, remain the leading cause of trauma-related death and disability globally, underscoring the urgency of addressing these disparities in care.