Understanding Outcomes of Pediatric Traumatic Brain Injury in Acute Care Settings: Social Determinants of Health, Injury Severity, and the Surprising Role of Bilingualism

Background/Objective Current research indicates that healthcare disparities begin early and continue throughout hospitalization. While social determinants of health (SDOH) and injury characteristics have been shown to influence pediatric TBI outcomes independently, there is limited research on how these factors affect PICU LOS. This study aimed to explore the associations between injury-related and SDOH with Pediatric Intensive Care Unit length of stay (PICU LOS) before admission to inpatient rehabilitation for pediatric patients with traumatic brain injury (TBI). Methods A retrospective review of clinical registry data from 81 patients aged 5–18 admitted to a children's hospital was conducted. Independent variables included injury severity (lowest Glasgow Coma Score [GCS]), sex assigned at birth (SAAB), race/ethnicity, family language, and Area Deprivation Index (ADI). Generalized linear regression models were used to examine the relationships between these variables and PICU LOS. Results Patients with lower GCS scores experienced significantly longer PICU LOS (β = -0.25, p = .009). A significant interaction between family language and ADI indicated that bilingual families from disadvantaged areas had longer PICU LOS (β = 2.23, p < .001). Additionally, an interaction between SAAB and family language showed that bilingual male patients had longer LOS (β = − .69, p = .001). Conclusions Injury severity and SDOH coalesce to influence PICU LOS in our sample of pediatric TBI patients. Bilingualism, particularly in families from disadvantaged areas, was surprisingly associated with longer PICU LOS compared to monolingual English or Spanish-speaking families. Our findings highlight family bilingualism as a unique and nuanced variable that moderates PICU LOS, which has not yet been thoroughly examined in the literature. The study underscores the importance of considering language fluency and health literacy when delivering care to diverse populations.