Social Determinants of Health Influence Mild Traumatic Brain Injury Symptom Burden: A Retrospective Study

Traumatic brain injury (TBI) affects over 69 million people worldwide, most of whom suffer a so-called "mild" injury. Patients with mild TBI, defined as a Glasgow Coma Scale (GCS) of 13-15 on presentation, often have a significant symptom burden as detected by the Rivermead Post-Concussion Questionnaire (RPQ). In this study, we aimed to determine whether social determinants of health (SDOH) may influence patient self-report of symptoms within a month of injury.

Patients presenting to an academic Level I trauma center with GCS 13-15 were included in the study with data collected as part of a prospectively maintained neurotrauma registry. Overall, 451 individuals completed the RPQ at a follow-up clinic visit. Demographic variables, injury characteristics, comorbidities, and geocoded SDOH information were captured from the electronic medical record. Multivariable regression analysis was performed.

Variables contributing to increased symptom burden on the RPQ included sex, living in an area with a high fraction of poverty, history of depression or anxiety, initial GCS score, history of illicit drug use, obesity, and positive head CT.

In addition to the expected patient and injury characteristics, fraction living in poverty was a significant variable contributing to scores on the RPQ-3 and RPQ-13. Efforts to incorporate screening for SDOH factors should be considered to identify patients at risk of poor recovery after mild TBI.