JMIR Publications

ABSTRACT

Background:

Traumatic Brain Injury (TBI) in children disrupts cognitive, physical, and emotional functioning, posing a significant public health challenge in the United States. Recovery after pediatric TBI is non-linear, influenced by fluctuations in cognitive and physical progress, which can be further shaped by social determinants of health (SDoH) factors, including sociodemographic features and healthcare access.

Objective:

This manuscript aims to investigate how SDoH influences phenotyping and their recovery trajectories. Particularly, the retrospective cohort analysis evaluates health disparities among pediatric patients and examines how these disparities influence health outcomes following TBI.

Methods:

The cohort of 926 pediatric patients was extracted from the Children’s Health After Injury (CHAI) dataset, to ensure consistency across five key variables: Abbreviated Injury Scale (AIS), Vital Signs and Assessments, Comorbidities, Complications, and Glasgow Coma Scale (GCS) scores. Dimensionality reduction, followed by density-based hierarchical clustering, were applied to identify distinct phenotypes and their SDoH characteristics. Further, exploratory analysis revealed distinct recovery trajectories over the phenotypes. To confirm the effect of SDoH factors on the phenotypes, generalized linear modeling and Random Forest method were used.

Results:

The four distinct TBI phenotypes exhibited unique severity scale correlations and recovery trajectories, which has implications for the SDoH features. Adolescents with high injury severity and stable GCS: This cohort comprised 278 patients and exhibited a significant positive correlation with age group (coefficient = 0.0807, p-value = 0.026). This group demonstrated a gradual progression of psychological and behavioral impairments, suggesting a persistent emotional burden. Younger children with moderate injuries and stable GCS: This cohort consisted of 141 patients, and no significant SDoH associations were observed (all p-values > 0.05). It exhibited stable psychological outcomes but tended to follow long-term worsening of neurological and physical conditions, which necessitates ongoing monitoring. Critically injured children with severe neurological impairment: This critical cohort comprised 98 patients and exhibited significant associations with race/ethnicity (coefficient = 0.4048, p-value = 0.001) and a negative interaction between age group and race/ethnicity (coefficient = -0.1437, p-value = 0.003). It consistently exhibited escalating psychological issues and fluctuating neurological conditions, underscoring the need for continuous support and pain management interventions. Moderately injured children with stable GCS, followed by sharp progression: This cohort consisted of 409 patients and did not exhibit statistically significant SDoH associations (all p-values > 0.05). Patients in this cluster often experienced a rapid escalation of psychological issues and a sharp deterioration of neurological conditions, emphasizing the urgent need for support.

Conclusions:

Disparities in sociodemographic characteristics evident among the phenotypes will help identify pediatric patients at high risk for persistent sequelae from TBI and develop targeted interventions to treat these individuals. Clinical Trial: None