Traumatic Brain Injury (TBI) is a significant public health concern in the United States, particularly among children and adolescents participating in sports and recreational activities. 1, 2 According to recent report, more than 600,000 emergency department (ED) visits, more than 65,000 hospitalizations, and more than 6,000 deaths due to TBI occurred among children and adolescents in the United States in a year. [3] Nearly half of TBI-related ED visits are due to sports and recreational activities among children and adolescents and more than two-thirds of ED visits for sports and recreation-related TBI (SR-TBI) are among this age group. [1] Most SR-TBI are mild with only a relatively small number resulting in ED visits and an even smaller number resulting in hospitalizations; however, those resulting in ED visits and hospitalizations are often more severe compared to those treated in outpatient clinics. [4] Caused by impact to the head or body or a penetrating injury, TBI can have devastating consequences for children, including long-term cognitive, behavioral, and physical impairments. [1]

Recent research suggests that social vulnerability may play a significant role in TBI hospitalizations among pediatric patients. [3] Social vulnerability refers to the degree to which individuals and communities are at risk of harm due to sociodemographic and socioeconomic factors such as race/ethnicity, age, poverty, low education levels, limited access to healthcare, and social isolation. [5] Studies have found that children and adolescents from socially vulnerable backgrounds or communities are at increased risk of sustaining TBIs and experiencing adverse outcomes such as prolonged hospital stays and higher rates of mortality. [6] For instance, a recent report from the U.S. Centers for Disease Control and Prevention (CDC) shows that racial and ethnic minority children, and children who live in rural areas have higher rates of hospitalizations and deaths from TBI. [6] While a number of studies have explored the impact of individual social vulnerability, such as race/ethnicity and socioeconomic status, on TBI, only a few studies have explored this relationship for SR-TBI among pediatric patients, and no studies to date have explored the role of neighborhood social vulnerability on all SR-TBI or SR-TBI hospitalizations. 3, 7

This study explored the characteristics of patients, hospital, and neighborhood for SR-TBI hospitalizations versus non-SR-TBI hospitalizations. This study also examined the relationship between individual (i.e., race/ethnicity, age, sex and insurance status) as well as neighborhood social vulnerability (i.e., overall social vulnerability index and urban-rural location) and SR-TBI hospitalizations among pediatric patients in the United States.