A Population-Based Study of the Incidence, Medical Care, and Medical Expenditures for Pediatric Traumatic Brain Injury

Exploring racial disparities and inequalities among children and youth with acquired brain injury: a systematic review

PURPOSE

Racial minoritized children and youth with acquired brain injury (ABI) often experience multiple forms of discrimination. The purpose of this systematic review was to understand the racial disparities in health care among children and youth with ABI and their caregivers.

METHOD

Six international databases (Ovid Medline, Embase, Healthstar, Psychinfo, Scopus, and Web of Science) were systematically searched for peer-reviewed articles. Studies were screened by two researchers who also conducted the data extraction and quality appraisal. A narrative synthesis approach was used to analyze the data.

RESULTS

Of the 8081 studies identified in the search, 34 met the inclusion criteria, which involved 838,052 children and youth with brain injuries (or caregivers representing them) across two countries. The following themes were noted in the studies in our review: (1) racial disparities in accessing care (i.e., diagnosis, hospital admission, length of stay, rehabilitation treatment); (2) racial disparities in ABI-related health outcomes (i.e., functional outcomes and mortality rates); and (3) factors affecting racial disparities (i.e., sources in injury, insurance and expenditures, and intersectionality).

CONCLUSIONS

Our findings reveal the concerning racial disparities among children and youth with ABI. Further research should explore solutions for addressing such racial disparities and solutions to address them.

A scoping review of research on potential impact of implicit bias in healthcare settings for children with acquired brain injuries

PURPOSE/OBJECTIVE

Acquired brain injury (ABI) is a leading cause of disability in children and adolescents. Implicit biases within pediatric ABI healthcare settings may exert negative effects on clinical interactions and medical decision-making processes. This study aimed to conduct a scoping review of current research that examines the potential impact of implicit biases in such healthcare settings for children with ABI.

RESEARCH METHOD/DESIGN

Following PRISMA-ScR guidelines, a search among five databases (CINAHL, Cochrane CENTRAL, PubMed, PsycArticles, and PsycInfo) was conducted, followed by abstract/full-text screening and data extraction. Main characteristics of the included studies, including research design, relevance to implicit biases, and public health impact were synthesized. The risk of bias of included studies was assessed.

RESULTS

Out of the 203 articles returned from the literature search, a total of three studies met the inclusion criteria for the present review. All studies examined the relevance of racial/ethnic biases for evaluating abusive head trauma or nonaccidental trauma. The included studies had an overall unclear to low risk of biases.

CONCLUSIONS/IMPLICATIONS

This scoping review identified scarce but emerging evidence of the presence and detrimental impact of potential implicit biases on the access and quality of care received by children with ABI. More research is needed to examine the causes, process mechanisms, and consequences of implicit biases in pediatric ABI healthcare settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Economic Burden of Injuries in Children With ADHD in the U.S. From 2011 to 2020

OBJECTIVE

Few studies have examined the economic burden of and sociodemographic disparities in injuries on families of children with ADHD on a national scale. The objective of this study was to address these literature gaps.

METHODS

Data from 7,102 children with ADHD aged 5 to 17 years in the Medical Expenditure Panel Survey 2011 to 2020 were analyzed for national trends, annualized average, and sociodemographic disparities in injury-related medical expenditures among children with ADHD.

RESULTS

The national economic burden of injuries for children with ADHD has nearly doubled over the10-year period. These costs were covered by private insurance (62%), public insurance (29%), and families (9%). Asian race was associated with higher total and family expenditures while having low income and public insurance were associated with lower family expenditures.

CONCLUSIONS

Families and society carry significant and increasing economic burdens related to injuries in children with ADHD. Sociodemographic disparities are substantial and of policy relevance.

The Influence of the Family Functioning and Social Relationships on Child Participation After Traumatic Brain Injury

PURPOSE

To describe the relationship amongst child and family characteristics (e.g. social relationships, family functioning) and child participation after traumatic brain injury (TBI) an average of 2.65 years post-TBI (SD = 2.12).

METHOD

Cross-sectional, secondary analysis of data collected as part of a larger research project.

RESULTS

N = 44 children with TBI. Analysis revealed statistically significant correlations between child participation, family functioning, and child characteristics.

CONCLUSIONS

School-aged children with TBI might experience chronic participation restrictions, associated with challenges in family functioning. Professionals can support children with TBI and their families through follow-up services that include a focus on family-based interventions to better support long-term outcomes for this population.

Health Inequities in Pediatric Trauma

This review article highlights the disparities evident in pediatric trauma care in the United States. Social determinants of health play a significant role in key aspects of trauma care including access to care, gun violence, child abuse, head trauma, burn injuries, and orthopedic trauma. We review the recent literature as it relates to these topics. The findings from these recent studies emphasize the important principle that trauma care for children should be designed with a focus on equity for all children.

An Exploratory Study on Disparities in Service Provision and Long-Term Need After Early Childhood Acquired Brain Injury

PURPOSE

While health care and educational disparities are known to impact minoritized groups, few research studies have been conducted to examine disparities after childhood acquired brain injury (ABI). The purpose of this study was to explore child and injury factors (i.e., race, socioeconomic status, and length of hospital stay) associated with referral, parent education, and long-term need for children who experienced an early childhood ABI.

METHOD

This study was a secondary analysis of data collected through retrospective cohort chart review and prospective caregiver phone surveys.

RESULTS

Exploratory logistic regressions indicated a statistically significant association between child and injury factors and (a) referral to rehabilitation or educational services at hospital discharge (p < .001) and (b) caregiver-reported long-term needs (including both met and unmet needs) for special education services (p = .009). The models for caregiver-reported receipt of education on ABI and caregiver-reported unmet need for special education were not significant. For both significant models, there were no significant individual predictors.

CONCLUSIONS

Differences in acute and long-term service provision and need after childhood ABI are likely influenced by a complex interaction of individual, injury, and social-environmental factors. Future research should consider how health care and education practice and policy might account for these interactions to support more equitable access to and utilization of services to improve long-term outcomes for all children with ABI.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21158878.

VR-based cognitive rehabilitation for children with traumatic brain injuries: Feasibility and safety

PURPOSE/OBJECTIVE

Traumatic brain injury (TBI) is a leading cause of acquired disability in children, who are at risk of significant impairment in executive function (EF). Virtual reality technology provides a novel strategy to offer rich and immersive training content that is both appealing to children and of potential value in improving their daily functioning. The present study aimed to evaluate the feasibility and safety of implementing an innovative VR-based interactive cognitive training (VICT) system for EF rehabilitation designed to meet the developmental and clinical needs of children with TBI.

RESEARCH METHOD/DESIGN

A parallel-group random-block randomized controlled trial was conducted among 26 children 7-17 years with TBI, who completed baseline, postintervention, and 2-month follow-up visits. Feasibility was assessed for recruiting children, measuring outcomes, and implementing the intervention. VR satisfaction was assessed via 5-point Likert scales. Safety outcomes included simulator sickness (0-4) and physical exertion (6-20). Preliminary efficacy was assessed by NIH Toolbox Cognitive Battery tasks.

RESULTS

Findings supported the feasibility of recruitment, outcome assessment, and delivery of the intervention. The intervention group reported adequate VR satisfaction in terms of pleasure (M = 3.25, SD = .50) and motivation (M = 2.75, SD = .96), as well as low levels of physical exertion (M = 6.25, SD = .50) and simulator sickness (M = .16, SD = .19). Preliminary evidence supported potential efficacy of the intervention, particularly for moderate and severe TBIs.

CONCLUSION/IMPLICATIONS

The present study found high feasibility, safety, and preliminary efficacy of the VICT system. Further research is required to fully examine the intervention's efficacy as a possible rehabilitation tool for children with TBI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Application of Second-Order Growth Mixture Modeling (SO-GMM) to Longitudinal TBI Outcome Research: 15-year Trajectories of Life Satisfaction in Adolescents and Young Adults (AYA) as an Example

OBJECTIVE

To demonstrate the application of Second-Order Growth Mixture Modeling using life satisfaction among adolescents and young adults with TBI up to 15 years post-injury.

DESIGN

SO-GMM, a data-driven modeling approach that accounts for measurement errors, was adopted to uncover distinct growth trajectories of life satisfaction over 15 years post-injury. Membership in growth trajectories was then linked with baseline characteristics to understand the contributing factors to distinct growth over time.

SETTING

Traumatic Brain Injury Model System National Database PARTICIPANTS: 3,756 AYAs with TBI aged 16 - 25 (M_age=20.49, SD_age=2.66; 27.24% female) INTERVENTIONS: Not Applicable MAIN OUTCOME MEASURES: Satisfaction with Life Scale RESULTS: Four quadratic growth trajectories were identified: low-stable (16.6%) that had low initial life satisfaction and remained low over time; high-stable (49.3%) that had high life satisfaction at the baseline and stayed high over time; high-decreasing (15.8%) that started with high life satisfaction but decreased over time; and low-increasing (18.2%) that started with low life satisfaction but increased over time. Sex, race, pre-injury employment status, age, and FIM cognition were associated with group assignment.

CONCLUSION

This study applied SO-GMM to a national TBI database and identified four longitudinal trajectories of life satisfaction among AYAs with TBI. Findings provided data-driven evidence for development of future interventions that are tailored at both temporal and personalized levels for improved health outcomes among AYAs with TBI.