Background/Rationale: Participation refers to involvement in meaningful social roles, such as work or school, relationships, and leisure activities. Moderate to severe traumatic brain injury (TBI) is known to affect frequency of participation in these activities. However, participation frequency is not always equivalent to participation satisfaction. A better understanding of meaningful participation that reflects a person’s abilities and values may aid in identifying better targets for rehabilitation after TBI.

Main Objective: To determine the contribution of various dimensions of participation to satisfaction with social roles and abilities in a sample of individuals with complicated mild to severe TBI.

Methods (including design, setting, sample/patient characteristics, and measures): Secondary analysis of baseline data from participants enrolled in a longitudinal intervention trial. We used data from 127 participants [mean age=35.24; 64.6%; predominately female (64.6%) and non-Hispanic White (70.1%)] who had completed a demographic questionnaire, portions of the TBI Quality of Life Scale (TBI-QOL), and the Participation Assessment with Recombined Tools-Objective (PART-O). Results: We performed a hierarchical regression to predict satisfaction with social roles and abilities using different dimensions of participation including objective (PART-O Out-and-About, Social Relations, and Productivity scores) and subjective (TBI-QOL Ability to participate in social roles and activities, Independence, and Stigma) dimensions. PART-O scores explained 17% of the variance [R2change=.17, p<.001] in satisfaction with social roles and abilities. Ability to participate in social roles and activities and Independence explained 40% of additional variance [R2change =.40, p<.001] in satisfaction with roles and abilities. Stigma explained an additional 2.3% of the variance [R2change =.023, p=.01].

Conclusions/Future Implications: How one perceives their abilities to participate and be independent, rather than the objective frequency of participation, accounted for a larger portion of the variance in how satisfied one was with their ability to participate in social roles and activities. Investigating different dimensions of participation in this population, rather than simply frequency, may result in more meaningful participation in this population.

Introduction: Diffuse axonal injury (DAI) is a subtype of traumatic brain injury (TBI) thought to portend poor outcomes, perhaps prompting early withdrawal of life-sustaining therapies. However, large-scale studies are limited. Because DAI can be subtle or invisible on initial head CT imaging, diagnostic delay is common until other causes of encephalopathy are ruled out and MRI can be performed safely. We hypothesized that TBI with DAI would have increased in-hospital mortality compared to comparable TBI without DAI in a large nationwide database.

Methods: This retrospective cohort study included adults from the 2017-2020 American College of Surgeons Trauma Quality Improvement Program admitted with blunt, moderate-severe TBI. Exclusion criteria were bilateral nonreactive pupils. We compared patients with and without DAI and adjusted for age, injury severity score (ISS), presenting hemodynamics, TBI severity, and hospital characteristics. Logistic regression was used for the binary outcomes of inpatient mortality and hospital discharge disposition (proxy for short-term functional status). Linear regression was used for the continuous outcomes of time to intracranial pressure monitor (ICPm) placement and hospital length of stay (LOS).

Results: Of 65,448 patients with moderate-severe TBI (median GCS 8 [interquartile range, IQR 6,10]), 7765 patients (12%) had DAI. DAI patients were significantly younger (median 36 years [25,55] vs. 55 years [32,71]) with higher ISS (33 [26,38] vs. 25 [17,29]), less midline shift (16% vs. 30%), and higher ICPm usage (43% vs. 24%, p<0.01). In multivariable analyses, DAI was associated with lower inpatient mortality (odds ratio [OR] 0.967, 95%CI 0.956-0.978), a 3.2-hour delay in ICPm placement (95%CI 0.1-6.3h), more than 3 days longer LOS (95% CI: 3.33-4.18), and worse short-term functional status (OR 1.06, 1.05-1.07) as measured by hospital discharge disposition.

Conclusion: Previous beliefs about early mortality and withdrawal of life-sustaining care for DAI are challenged by our findings. Further research is needed to clarify reasons for delays in ICPm placement (e.g., diagnostic delay, fatalism, etc.), and to determine if ICPm placement even improves outcomes in DAI. Although DAI prolongs hospitalization and is associated with worse functional status at discharge, the long-term trajectories of recovery remain unknown.

INTRODUCTION: Traumatic brain injuries (TBI) are chronic conditions requiring ongoing care. However, the long-term supports needed by people with moderate-severe TBIs are often not in place after inpatient care, despite community living constituting most of their lifetime. This is complicated by the fact that care quality varies tremendously depending on socio-economic and regional factors, often disproportionately affecting equity-deserving groups. Despite these challenges, few jurisdictions have developed care quality evaluation strategies grounded in evidence-based, standardized, and equity-focused care pathways that span the care continuum.

OBJECTIVES: To 1) evaluate TBI care quality and equity within the context of the care pathways approach and 2) use Quality Indicator data to identify system-level gaps and target improvement initiatives.

METHODS: Residents admitted to acute care with a formal TBI diagnosis between 2016 to 2022 were identified using administrative databases (e.g., Discharge Abstract Database, National Ambulatory Care Reporting System, Ontario Health Insurance Plan, and National Rehabilitation Reporting System). From this cohort, data for 13 Quality Indicators were collected to reflect the stages of the TBI care pathway: pre-acute (n=2 indicators), acute (n=1), rehabilitation (n=3), community (n=7).

FINDINGS: A total of 34,431 incident cases of TBI with hospital stay were identified. Over half of the people with TBI in this cohort were older adults (65+), and nearly 70% sustained their injury by falling. Older adults had a substantially higher incidence rate of moderate-severe TBI (39 per 100,000 for 65–79-year-olds and 173 per 100,000 for those aged 80+) than the overall rate (19 per 100,000). People with pre-existing cognitive comorbidities had an incidence rate six times higher than that for people without such comorbidities (161 per 100,000 vs 26 per 100,000). Admission to inpatient rehab was low across the province, with 22% of moderate-severe TBI patients admitted to any inpatient rehab and only 9% admitted to a specialized facility. For older adults, people with cognitive comorbidities, and people in Northern Ontario, specialized inpatient rehab admission was further limited. Of those who did not receive inpatient rehab, 55% were not followed-up by any medical professional in the community within 30 days of acute discharge. Within one year of acute discharge, just 10% were followed-up by a relevant specialist (e.g., physiatrist).

CONCLUSION: Care quality and equity gaps were identified in the rehabilitation and community stages of care. Admission to specialized inpatient rehabilitation was extremely limited, particularly in Northern regions, and for older adults and people with cognitive comorbidities, despite the latter groups being at higher risk of sustaining these injuries. Few people with TBI received timely primary care follow-up in the community. It is imperative to target injury prevention and quality improvement efforts toward these inequities and gaps to enhance TBI care quality, improve long-term outcomes, and optimize recovery.

Traumatic brain injury (TBI) exposures and poor health and functional outcomes are well established, particularly in the context of traumatic stressors common among those with histories of military deployments. Our team is advancing precision medicine approaches to predicting longitudinal outcomes through largescale, multi-study data harmonization and machine learning analytics. We combined data from the two largest mild TBI (mTBI) longitudinal cohort studies: The Long-Term Impact of Military-Relevant Brain Injury Consortium Chronic Effects of Neurotrauma Consortium (LIMBIC) Prospective Longitudinal Study (PLS) is a 10-year, 17-site cohort of more than 2,800 combat exposed service members and veterans. The Translational Research Center for TBI and Stress Disorders (TRACTS) is a VA RR&D National Center for TBI research including a 15-year, 2-site longitudinal cohort study of more than 950 combat exposed veterans. This proof-of-concept, precision medicine approach to mTBI longitudinal outcome research includes: 1) defining standardization methods and creating a crosswalk for the modalities and domains of LIMBIC and TRACTS longitudinal cohorts to create a unified assessment profile; 2) identifying a rigorous harmonization approach to allow for overall data analyses using the unified data set; 3) developing a multi-modal, analytic approach for the harmonized data sets; 4) pilot testing the use of a VA-supported machine-learning approach to identify multimodal patterns relevant to predicting long-term posttraumatic brain health; 5) establishing a program of research to analyze the prospective, longitudinal dataset and enable identification of risk factors associated with brain disorders and recovery; and, 6) developing, pilot testing, and proposing follow-up “FAIR” (Findable, Accessible, Interoperable, Reusable) data methods to apply the systems developed in this proposal to incorporate additional relevant, largescale, longitudinal veteran/military data (e.g., Million Veteran Project, VA Electronic Health Record Corporate Data Warehouse) to this robust data resource. We will present harmonized biomarker, imaging, functional, and mental health meta-data, outcomes, and methods designed to be scalable and publicly accessible to further advance precision medicine analytics for TBI.

BACKGROUND: This presentation describes the knowledge translation approach that the Model Systems Knowledge Translation Center (MSKTC) and Traumatic Brain Injury Model System (TBIMS) researchers take to develop and disseminate user-friendly print and video resources to promote rehabilitation outcomes for people living traumatic brain injury (TBI). TBIMS centers provide clinical care and conduct research to improve the lives of people with TBI. The MSKTC supports TBIMS centers to conduct knowledge translation activities, identifies health information needs, and develops and disseminates information resources based on Model Systems research and available evidence. The MSKTC also collaborates with the Spinal Cord Injury Model System and Burn Injury Model System Programs to conduct similar knowledge translation activities. Both the MSKTC and the TBIMS are funded by the National Institute on Disability, Independent Living, and Rehabilitation Research, U.S. Department of Health and Human Services.

METHODS: Knowledge translation is “the exchange, synthesis and ethically-sound application of knowledge—within a complex system of interactions among researchers and users—to accelerate the capture of the benefits of research” (Canadian Institutes of Health Research, n.d.). To maximize the impact of research and development activities to improve the lives of patients and families, it is important to engage stakeholders throughout the entire process (Barwick, Dubrowski, & Petrecca, 2020; Bowen, Botting, Graham, & Huebner, 2016; Nguyen et al., 2020; Parry, Salsberg & Macauley, 2015). The MSKTC collaborates with the TBIMS researchers to apply knowledge translation strategies and engage TBI survivors and their family members to develop, test, and disseminate free research-based resources.

OUTCOMES: The MSKTC has worked with the TBI model system researchers to develop resources on over 30 rehabilitation topics in multiple user-friendly formats such as factsheets, infocomics, videos, narrated slides, and podcasts. A MSKTC user feedback survey showed that 90.8% of the participants strongly agreed or agreed that MSKTC factsheets directly “apply to me or someone I know;” and 87.3% rated MSKTC factsheet quality as good or excellent. Between January 1, 2012 to October 31, 2023, over 5 million people from over 203 countries consumed the TBI contents on the MSKTC.org website. The MSKTC.org has been the go-to place for high quality rehabilitation resources for people living with TBI in the US and across the globe.

CONCLUSION: Knowledge translation can be an effective framework to help researchers better understand the needs of patients with TBI and families and develop strategies to meet their needs and improve their rehabilitation outcomes.