Socioeconomic factors in inflicted traumatic brain injury: Examining the area deprivation index.

The main analyses used only children living in Colorado, because ADI differed by state, so findings may not apply to children from surrounding states. The study used community-level ADI rather than family-level measures such as insurance type, parental age, or education, which the authors suggest may be more relevant. PICU length of stay was used as injury severity proxy, and the authors say it may not have captured severity nuances. The study was underpowered to detect small effects. Some addresses could not be geocoded, especially non-residential or commercial addresses, so children in hotels, RV parks, or remote locations may be missing. The sample was mostly White and may not represent other regions. All children were cared for in one hospital with a dedicated nurse and scheduling team that arranged transportation, accommodation, and reminders, which may have hidden ADI effects. The design was retrospective and not pre-registered.

Do not read the null findings for the neighborhood deprivation index as proof that community deprivation does not matter for children with inflicted brain injury. The study was underpowered for small effects, used a neighborhood index rather than family income or insurance, and took place in a clinic with dedicated follow-up coordination that may have reduced barriers.