183 - High Neighborhood Opportunity is Protective Against Functional Impairment after Pediatric Traumatic Brain Injury

Publication Number: 1172.183

Talia Magoon, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Abigail K. Tercek, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Michelle Clayton, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States; Ericka Fink, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Caitlin R. McNamara, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States

Background: The Child Opportunity Index (COI) is a validated, neighborhood-level measure of social context across education, health/environment, and socioeconomic domains. Lower COI has been associated with greater illness severity and longer length of stay in pediatric traumatic brain injury (TBI), but its association with functional impairment remains uncertain.

Objective: To determine whether COI is associated with functional impairment after pediatric TBI, including accidental TBI (aTBI) and abusive head trauma (AHT).

Design/Methods: Retrospective, single-center cohort study of children < 3 years admitted to the pediatric intensive care unit with TBI. COI scores were assigned based on state normed zip-code-level data and categorized as high, moderate, or low. Functional impairment was defined as Functional Status Score (FSS) increase >1 from pre-injury to hospital discharge, short term (11 months [IQR 4-13]) and long term (43 months [IQR 27-78]) follow-up. FSS was calculated using 6 domains; lower score indicates normal function. Data were obtained via chart review at each time point. Nonparametric analyses were performed comparing COI levels. Lasso was used to select covariates, followed by multivariable regression to determine adjusted associations.

Results: Among 906 patients, 26% resided in high-COI areas, 28% moderate, and 47% low. Most injuries were aTBI (n=581, 64%). AHT diagnosis did not differ by COI (31%vs moderate 36%, low 39%; p=0.148). High-COI patients had less severe TBI by Glasgow Coma Scale (GCS) score ( 9% vs moderate 17%, low 19%; p=0.001), and had less multi-organ dysfunction (14% vs moderate 26%, low 27%; p=0.009), neurosurgical interventions (3% vs moderate 9%, low 10%; p=0.024), impairment at hospital discharge (10% vs moderate 20%, low 24%; p< 0.001), short-term impairment (11% vs moderate 17%, low 18%; p=0.055), long-term impairment (11% vs moderate 13%, low 22%; p=0.010), and in-hospital mortality (2% vs moderate 6%, low 7%; p=0.036). After controlling for GCS and mechanism of injury, high COI remained associated with lower odds of impairment at hospital discharge (OR= 0.65 95% CI [0.34,1.21]), short term (OR= 0.74, 95% CI [0.41, 1.31]), and long term (OR= 0.62, 95% CI [0.32, 1.17]) follow-up.

Conclusion(s): There was no association between COI level and diagnosis of AHT. In this cohort, higher COI was associated with lower injury severity and more favorable functional and clinical outcomes. COI may help risk stratification in pediatric TBI and inform post-discharge planning. Future studies should assess rehabilitation resources in Low COI areas.

Frequency of Impairment