Social Environment and Neurobehavioral Outcomes 1 Year After Severe Pediatric TBI in the Intensive Care Unit

Aimee E Miley; Jamie Patronick; Nanhua Zhang; Rachel L Bode; Anthony Fabio; Amery Treble-Barna; Ranjit S Chima; Anna-Lynne R Adlam; Michael J Bell; Stephen R Wisniewski; Sue R Beers; Shari L Wade; Brad G Kurowski; TBI Genetics and Environment Study Team

doi:10.1097/HTR.0000000000000943

Social Environment and Neurobehavioral Outcomes 1 Year After Severe Pediatric TBI in the Intensive Care Unit

J Head Trauma Rehabil. 2024 Aug 12. doi: 10.1097/HTR.0000000000000943. Online ahead of print.

Authors

Aimee E Miley¹, Jamie Patronick, Nanhua Zhang, Rachel L Bode, Anthony Fabio, Amery Treble-Barna, Ranjit S Chima, Anna-Lynne R Adlam, Michael J Bell, Stephen R Wisniewski, Sue R Beers, Shari L Wade, Brad G Kurowski; TBI Genetics and Environment Study Team

Affiliation

¹ Author Affiliations: Divisions of Behavioral Medicine and Clinical Psychology (Ms Miley), Pediatric Rehabilitation Medicine (Ms Patronick and Drs Wade and Kurowski), Biostatistics and Epidemiology (Dr Zhang), and Critical Care Medicine (Dr Chima), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Psychology, University of Cincinnati, Cincinnati, Ohio (Ms Patronick and Dr Wade); Departments of Pediatrics (Drs Zhang, Chima, Wade, and Kurowski) and Neurology and Rehabilitation Medicine (Ms Bode and Dr Kurowski), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania (Drs Fabio and Wisniewski); Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Treble-Barna); School of Psychology, Faculty of Health and Life Sciences, University of Exeter, Exeter, England (Dr Adlam); Department of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia (Dr Bell); and Department of Psychiatry and Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Dr Beers).

PMID: 39146436
DOI: 10.1097/HTR.0000000000000943

Abstract

Objective: To examine the association of home and neighborhood environment with neurobehavioral outcomes after severe pediatric traumatic brain injury (TBI).

Setting: Domestic and international children's medical centers.

Participants: Participants enrolled in the study were 18 years or younger at the time of their severe TBI (Glasgow Coma Scale [GCS] ≤ 8), admitted to the intensive care unit, and underwent placement of an intracranial pressure (ICP) monitor. Exclusionary criteria included less severe injury (GCS > 8), pregnancy, and/or ICP monitor placement occurred at a non-participating hospital.

Design: A multicenter, observational cohort study.

Main measures: Outcomes assessed at 12 months post-injury included measures of global functioning, intellectual ability, caregiver-report measures of family functioning, executive functioning behaviors, behavior problems, and health-related quality of life. We examined mortality risk (assessed acutely after injury), family functioning (assessed at 12 months post-injury) and parenting practices, social environment, and neighborhood stressors (all assessed > 12 months post-injury), as correlates and moderators of the 12-month post-injury outcomes.

Results: Home and neighborhood factors were associated with neurobehavioral outcomes (ie, intellectual ability, executive functioning, behavioral adjustment, and health-related quality of life) but not with global functioning outcomes. A negative association between a more vulnerable home and neighborhood environment and neurobehavioral outcomes was more consistent in older children compared with younger children, based on age of injury. The influence of mortality risk on neurobehavioral outcomes was variable.

Conclusion: Parenting practices and quality of social and neighborhood environment are associated with neurobehavioral outcomes 12 months after severe pediatric TBI. More research is needed to better understand the relationship between home/neighborhood stressors and TBI recovery to develop and implement strategies for patients and families to optimize outcomes. Future intervention development should focus on addressing parenting practices and social environment in a developmentally sensitive way for children who have sustained a severe TBI.