Social determinants of participant recruitment and retention in a prospective cohort study of pediatric mild traumatic brain injury

Background

Prior studies have shown poor recruitment and retention of minoritized groups in clinical trials.

Objective

To examine several social determinants as predictors of consent to participate and retention as part of a prospective, longitudinal cohort study of children 8–16 with either mild traumatic brain injury (mild TBI) or orthopedic injury (OI).

Methods

Children and families were recruited during acute visits to emergency departments (ED) in two large children's hospitals in the midwestern United States for a prospective, longitudinal cohort study of children 8–16 with either mild TBI or OI.

Results

A total of 588 (mild TBI = 307; OI = 281) eligible children were approached in the ED and 315 (mild TBI = 195; OI = 120) were consented. Children who consented did not differ significantly from those who did not consent in sex or age. Consent rates were higher among Black (60.9%) and multi-racial (76.3%) children than white (45.3%) children. Among the 315 children who consented, 217 returned for a post-acute assessment (mild TBI = 143; OI = 74), a retention rate of 68.9%. Participants who were multi-racial (96.6%) or white (79.8%) were more likely to return for the post-acute visit than those who were Black (54.3%).

Conclusions

Racial differences exist in both recruitment and retention of participants in a prospective, longitudinal cohort of children with mild TBI or OI. Further work is needed to understand these differences to ensure equitable participation of minoritized groups in brain injury research.

Comparison of a warm gutta-percha obturation technique and lateral condensation

This study was designed to compare a warm gutta-percha obturation technique, Thermafil Plus (Tulsa Dental, Tulsa OK), with lateral condensation for the ability to adapt gutta-percha to the walls of a root canal system. An extracted sectioned and mounted maxillary central incisor had canal irregularities created and was subsequently subjected to multiple obturations using both techniques. Length of fill, replication to working length, number of artificial depressions replicated, quality of replications, number of voids, and general appearance of obturation were all evaluated using standardized criteria. Data evaluation consisted of a one way analysis of variance on the same type defects between obturation groups followed by a Scheffé post-hoc test. A statistically significant difference was found between the groups in each category of evaluation. Gutta-percha using Thermafil was better able to flow into lateral spaces, had fewer voids, and replicated the surface of the root better. It also, however, was extruded out the apical foramen more than in the lateral condensation group.

Mortality rates by stage-at-diagnosis

Mortality rates by stage-at-diagnosis are not possible from usual mortality data. Normally, mortality data are based solely on information provided on death certificates, and stage-at-diagnosis is not generally reported on these documents. However, mortality rates by stage are possible when one can link diagnostic data with mortality data. Population-based cancer registries collect these types of data routinely in determining the survival of cancers in their registry. Thus, using cancer registry data, mortality rates by stage-at-diagnosis can be calculated. We report stage-specific mortality rates for the Surveillance, Epidemiology, and End Results Program, representing 10% of the cancers in the U.S. for the four sites with the largest mortality rates for females and for males. For an individual site, the stage-specific mortality rates allow one to determine how the different stages are contributing to the trends in all stage mortality. For example, distant disease mortality is the largest contributor to all stage cancer mortality for female and male lung cancer, female colorectal cancer, ovarian cancer, prostatic cancer and male pancreatic cancer. In contrast, regional disease mortality is the largest contributor to all stage cancer mortality for breast cancer and male colorectal cancer. In addition, localized disease mortality is the second largest contributor to all stage mortality for breast cancer and prostate cancer.