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

BACKGROUND AND OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.