Epidemiology and outcomes of head trauma in rural and urban populations: A systematic review and meta-analysis

ObjectiveTo identify and describe differences in demographics, injury characteristics, and outcomes between rural and urban head injury patients. Data SourcesCINAHL, Emcare, MEDLINE, and Scopus. Review MethodsA systematic review and meta-analysis of studies comparing epidemiology and outcomes of rural and urban head trauma was conducted in accordance with PRISMA and MOOSE guidelines. Results36 studies with [~]2.5-million patients were included. Incidence of head injury was higher in males, regardless of location. Rates of transport-related head injuries, particularly involving motorized vehicles other than cars, were significantly higher in rural populations (OR:3.63, 95% CI[1.58,8.35], p=0.002), whereas urban residents had more fall-induced head trauma (OR:0.73, 95% CI[0.66,0.81], p<0.00001). Rural patients were 28% more likely to suffer severe injury, indicated by Glasgow Coma Scale (GCS)[&le;]8 (OR:1.28, 95% CI[1.04,1.58], p=0.02). There was no difference in mortality (OR:1.09, 95% CI[0.73,1.61], p=0.067), however, urban patients were twice as likely to be discharged with a good outcome (OR:0.52, 95% CI[0.41,0.67], p<0.00001). ConclusionsRurality is associated with greater severity and poorer outcomes of traumatic head injury. Transport accidents disproportionally affect those travelling on rural roads. Future research recommendations include addition of prehospital data, adequate follow-up, standardized measures, and sub-group analyses of high-risk groups, e.g., Indigenous populations.