(738) Traumatic Brain Injury Mechanism and Childhood Opportunity Affect Functional Outcome After Discharge

Introduction: Understanding functional outcomes is imperative to improving care of traumatic brain injury (TBI) patients. Abusive head trauma (AHT) presents a unique combination of new medical complexity with strained socioeconomic support during a critical period of neurodevelopment. Despite this, there is limited data comparing outcomes between TBI mechanisms or the effect of socioeconomic factors on outcome. We hypothesize that AHT subjects have worse functional outcomes compared to accidental TBI (aTBI) in the first year after discharge. Socioeconomic factors will modify this association.

Methods: A single center retrospective cohort study was conducted from January 2016 to March 2023 using the Childrens Wisconsin Trauma Registry and chart review. Subjects were less than age 3, admitted with moderate to severe head trauma, and had follow up within 15 months of discharge with neurology or physical medicine (PMNR). Functional Status Scale (FSS) scores were calculated with neurology and PMNR notes at 3-month intervals up to 15 months post discharge. Childhood opportunity index (COI) was determined using reported home address at time of follow up. Mann-Whiney and Chi-squared tests evaluated differences between abusive and non-abusive cohorts.

Results: Ninety-six and 41 subjects enrolled in the AHT and aTBI cohorts respectively. The AHT cohort was younger (mean 6 vs. 19 months, p< 0.0001). Abbreviated Injury Score (AIS) and Injury Severity Scores (ISS) were higher in AHT cohort (mean 4 vs. 3, p=0.0036 for AIS, and mean 24 vs. 17, p< 0.0001 for ISS). Hospital and ICU length of stay were longer in AHT cohort (mean 16 vs. 12 days, p=0.0001; and 6 vs. 4 days, p=0.0024, respectively). Discharge FSS was higher in the AHT cohort (mean 8.1 vs. 7.6, p=0.021). Significant differences in FSS score were not observed in univariable analysis at 3-month intervals following discharge.

Conclusions: Differences in age, severity at presentation, and length of stay were consistent with prior studies. Though FSS scores were worse at discharge for AHT subjects, further differences were not detected potentially secondary to loss to follow-up. Younger age at presentation may lead to lower FSS scores as deficits take time to develop. Further analysis will include random coefficient modeling and assessment of COI impact.