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Abstract
Traumatic brain injury (TBI) is a major contributor to morbidity and mortality among children, and outcomes may differ by geographic location. This study evaluated urban–rural disparities in mortality among Oregon pediatric TBI patients treated in trauma hospitals from 2009–2012. Patients aged 0–19 were identified from the Oregon Trauma Registry, and injury location was classified using the National Center for Health Statistics Urban–Rural Classification Scheme. Incidence rates were calculated using Census data, and multivariable logistic regression assessed associations between injury location and mortality, adjusting for demographic and clinical factors. Among 2,794 patients, 46.6% were injured in large metropolitan areas, 24.8% in medium/small metropolitan areas, and 28.6% in non-metropolitan areas. Rural children had the highest annualized TBI incidence (107/100,000) and higher Injury Severity Scores compared to metropolitan counterparts (71/100,000). Non-metropolitan injury location was associated with increased mortality (adjusted OR=1.91; 95% CI=1.11–3.30). These findings suggest significant urban–rural disparities in pediatric TBI incidence and outcomes, highlighting the need for targeted prevention and care strategies in rural regions.