Predictors of High School and College Graduation after Sustaining a Moderate-to-Severe Traumatic Brain Injury

Objective: To identify early predictors of US high school and college graduation after moderate-to-severe traumatic brain injury (TBI). Setting: Inpatient rehabilitation and community. Participants: TBI Model Systems participants, aged 16 to 24 years, enrolled as high school or college students at time of injury. Design: Prospective cohort study. Main Measures: Successful graduation was defined as having a diploma (high school) or an associate/bachelor's degree (college) at 1-, 2-, or 5-year follow-up. Predictors were sex, race/ethnicity, urbanicity, preinjury substance abuse, primary rehabilitation payer, and functional independence at inpatient rehabilitation discharge. Method: We descriptively characterized differences between those who did and did not graduate high school and college within the first 5 years postinjury and identified early predictors of successful high school and college graduation using 2 binomial logistic regressions. Results: Of those with known graduation status, 81.2% of high school and 41.8% of college students successfully graduated. Graduates in both groups were more often White than Black and had more functional independence at discharge. Among high school students, preinjury substance abuse was also a risk factor for not graduating, as was identifying as Hispanic or "other" race. Conclusions: Sociodemographic factors and disability influence graduation outcomes, requiring structural, institutional, and personal interventions for success.