Childhood TBI Associated With Additional Comorbidities

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Children with a TBI are more likely to have additional neurologic and physiologic comorbidities.

Children with a traumatic brain injury (TBI) are more likely to have additional neurologic and physiologic comorbidities, including depression and bone and joint issues, than children without TBI, according to a study in JAMA Pediatrics.

Additionally, the researchers of the study found that states with a higher prevalence of childhood TBI are more likely to have children treated under private insurance, a finding of which the clinical implications have yet to be explored.

The cross-sectional US National Survey of Children’s Health telephone survey (2011-2012) was used to pool respondent data regarding TBI incidence in children. The researchers stratified TBI prevalence estimates by sociodemographic characteristics (eg, sex, race, age, Hispanic ethnicity, household income, health insurance status, and highest education achieved) and compared children with TBI vs without TBI in terms of the likelihood of reporting several different health conditions (eg, attention-deficit/hyperactivity disorder, hearing problems, anxiety and behavioral issues, and epilepsy or seizure disorder) throughout life.

Additionally, the researchers examined associations among insurance type, parent rating of insurance adequacy, and TBI prevalence.

According to survey responses, the weighted estimated population of children with TBI was 1,850,000, or a lifetime estimate of 2.5% (95% CI, 2.3%-2.7%) of parent-reported TBI.

In the analysis adjusted for sociodemographic characteristics, children with a lifetime TBI history were more likely to have depression (adjusted prevalence ratio [aPR], 10.9 [95% CI, 8.7-13.5] vs 3.2 [95% CI, 2.9-3.5]), anxiety (aPR, 13.2 [95% CI, 11.0-16.0] vs 4.3 [95% CI, 4.1-4.6]), epilepsy or seizure disorder (aPR, 7.9 [95% CI, 5.8-10.7] vs 1.0 [95% CI, 0.9-1.1]), vision problems (aPR, 6.7 [95% CI 4.8-9.4] vs 1.6 [95% CI 1.4-1.8]), attention-deficit/hyperactivity disorder (aPR, 20.5 [95% CI, 17.4-24.0] vs 8.5 [95% CI, 8.1-8.9]), and bone, joint, or muscle problems (aPR, 14.2 [95% CI, 11.6-17.2] vs 2.8 [95% CI, 2.6-3.1]) compared with children without TBI.

In addition, states with parents reporting a higher childhood TBI prevalence had a higher proportion of children who were treated under private health insurance. These states included Colorado (age-adjusted prevalence [aAP], 4.26 [95% CI, 3.15-5.73]), Maine (aAP, 5.30 [95% CI, 4.06-6.88]), Montana (aAP, 4.29 [95% CI, 3.16-5.79]), North Dakota (aAP, 3.98 [95% CI, 2.84-5.56]), Pennsylvania (aAP, 5.01 [95% CI, 3.66-6.82]), South Dakota (aAP, 4.30 [95% CI, 3.13-5.88]), Vermont (aAP, 4.41 [95% CI, 3.35-5.77]), Washington (aAP, 3.38 [95% CI, 2.41-4.71]), and Wyoming (aAP, 4.20 [95% CI, 3.08-5.69]).

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States with higher TBI prevalence among children also had higher parent reports of adequate insurance quality vs reports of less-adequate coverage (odds ratio, 1.18; 95% CI, 1.16-1.36) and higher estimates of private health insurance vs public health insurance (odds ratio, 1.36; 95% CI, 1.27-1.46).

The main limitations of the study were the reliance on data from parent report rather than clinically recorded and/or confirmed diagnoses of TBI as well as the lack of information on whether associated health conditions preceded or followed TBIs.

Considering these findings suggest that TBI may affect the overall health of a child, the investigators indicate that, “improved care for children can be better achieved if pediatric healthcare professionals offer medical guidance to parents in the context of a child’s overall health history, including history of lifetime TBI.”


Haarbauer-Krupa J, Lee AH, Bitsko RH, Zhang X, Kresnow-Sedacca MJ. Prevalence of parent-reported traumatic brain injury in children and associated health conditions. JAMA Pediatr. 2018;172:1078-1086.