Quality of Life Following Pediatric TBI: Associations With Rural and Appalachian Residence and Recurrent TBI History

Objective: Pediatric traumatic brain injury (TBI) is a significant public health concern, often leading to long-term impairments in social, behavioral, cognitive, and physical outcomes. Individuals living in Appalachian and/or rural regions of the United States may be at increased risk of poorer outcomes after pediatric TBI. The current study examines the role of social determinants of health, specifically rural and Appalachian residence, on recurrent TBI risk and post-injury quality of life (QoL). Method: Participants were 150 adolescents aged 14 to 19 who were hospitalized with a moderate or severe TBI and enrolled in a family problem-solving intervention trial at least 1-month post-injury ( M = 4.63 years). Demographic and injury characteristics, history of recurrent TBI, and adolescent and caregiver-reported QoL were collected at baseline. Addresses were collected and coded as rural/non-rural and Appalachian/non-Appalachian according to the Rural-Urban Commuting area codes and Appalachian Regional Commission guidelines. Results: Rural adolescents were more likely to have had a history of recurrent TBI than non-rural adolescents. Adolescents who resided in both rural and Appalachian regions endorsed the poorest self-reported QoL. Recurrent TBI history was associated with poorer caregiver-reported QoL. Conclusions: Clinicians serving rural and Appalachian communities should prioritize behavioral health screening and increasing access to services. Injury prevention efforts should target rural regions to reduce TBI prevalence and associated disparities. Overall, this study underscores the need for comprehensive, culturally responsive care and systemic interventions to improve outcomes for adolescents with TBI in underserved areas.