Characterizing the associations between social determinants of health and functional recovery among pediatric inpatient rehabilitation traumatic brain injury patients.

OBJECTIVE To examine differences in functional outcomes in the acute period following pediatric traumatic brain injury (TBI) as they relate to social determinants of health (SDoH). Setting: An inpatient rehabilitation program at a children's hospital in the Mountain West region of the United States. Participants: Eighty-nine patients with a diagnosis of moderate-to-severe TBI (ages 5-18 years old).

DESIGN Data were extracted from a clinical registry. Correlations and generalized linear regression were used to examine the relationships among injury characteristics, sociodemographic factors, and functional outcomes.

MAIN MEASURES Injury severity categorized by Glasgow Coma Score (GCS), inpatient length of stay (LOS), individual-level SDoH, community-level SDoH, and change in Functional Independence Measure for Children (WeeFIM) from admission to discharge.

RESULTS Using generalized linear regression with the change in WeeFIM as the dependent variable, there was a significant interaction of race/ethnicity and Area Deprivation Index (ADI) (standardized β = .72, p = 0.02). There was also a significant main effect of LOS (standardized β = 0.27, p = 0.01).

CONCLUSIONS Acute functional recovery after pediatric TBI is complex and related to a number of patient factors. Specifically, social advantage and race/ethnicity coalesced to help explain the variance in functional recovery.