INS NYC 2024 Program

Poster	Poster Session 03 Program Schedule 02/15/2024 09:30 am - 10:40 am Room: Shubert Complex (Posters 1-60) Poster Session 03: Neurotrauma \| Neurovascular Final Abstract #29 Electronic Health Record Trends of Long-term Mental Health Problems in Children with Traumatic Brain Injury in Early and Middle Childhood Tess Guzman, Cincinnati Children's Hospital Medical Center, Cincinnati, United States Surbhi Bhatnagar, Cincinnati Children's Hospital Medical Center, Cincinnati, United States Alexis Mitelpunkt, Cincinnati Children's Hospital Medical Center, Cincinnati, United States Bruce Aronow, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, United States Shari Wade, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, United States Megan Narad, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, United States Brad Kurowski, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, United States Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Child) Keyword 1: traumatic brain injury Keyword 2: attention deficit hyperactivity disorder Objective: Traumatic brain injury (TBI) has a profound societal impact. Subsequently, mental health and behavioral issues are common following TBI, with younger age of injury conferring elevated risk. In this study, we examined the mental health outcomes of children injured between the ages 0-12 years old, up to 10 years post-TBI. Participants and Methods: We studied the mental health of children with TBI using 12 years of EHR data at a large tertiary care pediatric medical center, with a level 1 trauma designation. Data collected from January 1st, 2010, until December 31st, 2022, were examined. We excluded patients born before 1990 and with less than two visits. ICD9Diag and ICD10CM codes were used to identify cases with a TBI diagnosis. The first time we observed any TBI ICD codes (ICD9 - 850.XX to 859.XX or 907.XX and ICD10 - S06.XX) in a patient’s EHR, was selected as the date of TBI diagnosis. To ensure that we had sufficient post-TBI data for all cases, we only included children with TBI before the age of 12 years. Patients were followed 10-years post-TBI or until 21 years of age. Mental health problems/diagnosis were identified using CCSR Categories (MBD 001-014, 017-034). Patients were organized into one of two age at injury groups; Early Childhood (EC; Ages 0-5 years-old, N = 3707, age (mean=2.6, SD=1.6), sex (42.8% female)) and Middle Childhood (MC; Ages 6-12 years-old, N = 7322, age (mean=8.9, SD=1.6), sex (31.8% female)). Both groups were composed of the following racial distributions: EC = Black (18.3%), White (70.8%), Multiple Races (5%), Other (5.9%), MC = Black (19.6%), White (72.3%), Multiple Races (4.6%), Other (3.5%). Results: Both groups saw higher rates of mental health diagnoses within the first year of injury including ADHD, mood disorders, conduct disorders, and stress. Children who experienced an injury in EC had higher rates of ADHD, anxiety, developmental, and conduct disorders at 6+ years post injury, with rates of ADHD and anxiety remaining elevated for 10 years after injury. Children who experienced an injury in MC had higher rates of anxiety and depression that remained elevated for 8 years post injury. Conclusions: Observation of EHR trends indicated that TBI before age 6 confers higher rates of mental health diagnosis long-term. Higher rates of developmental and conduct disorders diagnoses are more likely following TBI in EC, while higher rates of mood disorder diagnoses are more likely following TBI in MC. While this study demonstrates the long-term mental health problems experienced following childhood TBI, it is unable to characterize the severity of these problems and what factors may contribute to them. Mental health problems already pose a growing issue for children and teens and TBI in early and middle childhood seems to exacerbate these issues. Future studies should investigate what factors might be associated with increased risk to better identify mental health problems following injury and streamline management over time.

Poster

02/15/2024
09:30 am - 10:40 am
Room: Shubert Complex (Posters 1-60)

Poster Session 03: Neurotrauma | Neurovascular

Final Abstract #29

Electronic Health Record Trends of Long-term Mental Health Problems in Children with Traumatic Brain Injury in Early and Middle Childhood

Tess Guzman, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
Surbhi Bhatnagar, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
Alexis Mitelpunkt, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
Bruce Aronow, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, United States
Shari Wade, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, United States
Megan Narad, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, United States
Brad Kurowski, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, United States

Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Child)

Keyword 1: traumatic brain injury
Keyword 2: attention deficit hyperactivity disorder

Objective:

Traumatic brain injury (TBI) has a profound societal impact. Subsequently, mental health and behavioral issues are common following TBI, with younger age of injury conferring elevated risk. In this study, we examined the mental health outcomes of children injured between the ages 0-12 years old, up to 10 years post-TBI.

Participants and Methods:

We studied the mental health of children with TBI using 12 years of EHR data at a large tertiary care pediatric medical center, with a level 1 trauma designation. Data collected from January 1st, 2010, until December 31st, 2022, were examined. We excluded patients born before 1990 and with less than two visits. ICD9Diag and ICD10CM codes were used to identify cases with a TBI diagnosis. The first time we observed any TBI ICD codes (ICD9 - 850.XX to 859.XX or 907.XX and ICD10 - S06.XX) in a patient’s EHR, was selected as the date of TBI diagnosis. To ensure that we had sufficient post-TBI data for all cases, we only included children with TBI before the age of 12 years. Patients were followed 10-years post-TBI or until 21 years of age. Mental health problems/diagnosis were identified using CCSR Categories (MBD 001-014, 017-034). Patients were organized into one of two age at injury groups; Early Childhood (EC; Ages 0-5 years-old, N = 3707, age (mean=2.6, SD=1.6), sex (42.8% female)) and Middle Childhood (MC; Ages 6-12 years-old, N = 7322, age (mean=8.9, SD=1.6), sex (31.8% female)). Both groups were composed of the following racial distributions: EC = Black (18.3%), White (70.8%), Multiple Races (5%), Other (5.9%), MC = Black (19.6%), White (72.3%), Multiple Races (4.6%), Other (3.5%).

Results:

Both groups saw higher rates of mental health diagnoses within the first year of injury including ADHD, mood disorders, conduct disorders, and stress. Children who experienced an injury in EC had higher rates of ADHD, anxiety, developmental, and conduct disorders at 6+ years post injury, with rates of ADHD and anxiety remaining elevated for 10 years after injury. Children who experienced an injury in MC had higher rates of anxiety and depression that remained elevated for 8 years post injury.

Conclusions:

Observation of EHR trends indicated that TBI before age 6 confers higher rates of mental health diagnosis long-term. Higher rates of developmental and conduct disorders diagnoses are more likely following TBI in EC, while higher rates of mood disorder diagnoses are more likely following TBI in MC. While this study demonstrates the long-term mental health problems experienced following childhood TBI, it is unable to characterize the severity of these problems and what factors may contribute to them. Mental health problems already pose a growing issue for children and teens and TBI in early and middle childhood seems to exacerbate these issues. Future studies should investigate what factors might be associated with increased risk to better identify mental health problems following injury and streamline management over time.