Poster Session 03 Program Schedule
02/15/2024
09:30 am - 10:40 am
Room: Majestic Complex (Posters 61-120)
Poster Session 03: Neurotrauma | Neurovascular
Final Abstract #61
Social-Environmental Factors as Mediators of Pediatric Traumatic Brain Injury Outcomes
Cristina Robles, Mercer University, Atlanta, United States
Laura Blackwell, Emory University, Atlanta, United States
Andrew Reisner, Children's Healthcare of Atlanta, Atlanta, United States
Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Child)
Keyword 1: traumatic brain injury
Keyword 2: intellectual functioning
Keyword 3: academic achievement
Objective:
Traumatic Brain Injury (TBI) is one of the leading causes of morbidity and mortality in pediatric patients. The impact of such injuries can be overarching, affecting both cognitive and social-emotional functioning. Outcome prognostication in TBI is important but challenging due to heterogeneity of the injury and is influenced by a combination of factors that include injury severity, genetics, and social-environmental factors. Little research has been dedicated to understanding how social-environmental factors interact with TBI medical risks to predict neurocognitive outcomes, particularly in children. Therefore, the aim of the current study is to examine the influence of social-environmental factors, including parental income and parental education, on overall cognition (IQ) and achievement (reading), across race groups in children with TBI, while accounting for aspects of injury severity.
Participants and Methods:
Data was obtained from a larger prospective, single-center cross-sectional study examining acute and long-term outcomes in pediatric TBI. Inclusion criteria for this study were participants with a recent history of TBI who were referred for a neuropsychological evaluation as part of the standard of care. The final sample included 40 children, ages 4-16 years (mean 10.7); 55% male; 43% identified as Black/African American, and 58% identified as White/Caucasian or White Hispanic. Patients completed an intellectual assessment (WISC-V; WASI-II; WPPSI-IV; DAS-II), and word reading tests (WRAT-5; WRAT-4; WIAT-4; WIAT-3; KTEA-3; WJ-IV). Parents completed questionnaires assessing the family environment (income, parental education). Additional data on injury severity, including patient’s lowest measured Glasgow Coma Scale (GCS) score at the time of admission, was abstracted from medical records, in which 75% of the participants' GCS scores fell in the severe range.
Results:
Two step-wise multi-linear regressions were completed to evaluate the impact of race and social determinants on IQ and reading. Results revealed significant differences in IQ (10.4 IQ score difference) when comparing children who were Black (mean SS = 88.0) versus White (mean SS = 98.4; p = .025); however, 26% of this variance was explained by caregiver education when entered into the model and an additional 6% when family income was entered into the model. After controlling for these variables, the differences in IQ became non-significant. Injury severity did not account for significant variance in the model after the other variables. For academics, there were no differences in reading outcomes observed between race, parent education, or income.
Conclusions:
Pediatric patients who sustain a TBI are at an increased risk for long-term cognitive deficits. Social-environmental factors have been shown to predict outcomes in other populations but have not been as well studied within pediatric TBI. Our study found that IQ outcomes were influenced more by social-environmental factors compared to injury severity. These findings suggest sociodemographic factors should be weighed heavily during the neuropsychological evaluation, including prioritizing and facilitating access to resources, referrals, and tailoring recommendations to families.
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