Characteristics Associated with the Use of an Inpatient Rehabilitation or Skilled Nursing Facility after Acute Care in Children with Severe Traumatic Brain Injury

ABSTRACT

To characterize inpatient rehabilitation services for children with severe traumatic brain injury (TBI), we included 254 children, whose parents/guardians reported receipt of rehabilitation within a 12-month follow-up period, from a multinational observational study. Children discharged to an inpatient rehabilitation or skilled nursing facility after acute care were classified into the “inpatient rehabilitation” group, and children discharged home after acute care were classified into the “non-inpatient rehabilitation” group. Multivariable regression analyses determined the associations of sociodemographic and clinical characteristics with rehabilitation groups. Children receiving inpatient rehabilitation had a shorter length of acute hospitalization. Children from the UK were less likely to receive inpatient rehabilitation compared to children from the US. Future studies are warranted to extend current findings by identifying the reasons behind differential access to inpatient rehabilitation among children with severe TBI.

KEYWORDS:

• Child
• severe traumatic brain injury
• inpatient rehabilitation
• non-inpatient rehabilitation

Acknowledgments

We thank all ADAPT Investigators: Shruti Agrawal, Addenbrookes Hospital, Cambridge, UK; Sarah Mahoney, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK; Deepak Gupta, All India Institute of Medical Sciences, New Delhi, India; John Beca, Auckland DHB Charitable Trust, Starship Children’s Hospital, Auckland, NZ; Laura Loftis, Baylor College of Medicine, Houston, TX; Kevin Morris, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK; Lauren Piper, Levine Children’s Hospital, Charlotte, NC; Anthony Slater, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia; Karen Walson, Children’s Healthcare of Atlanta, Atlanta, GA; Tellen Bennett, Children’s Hospital Colorado, Aurora, CO; Todd Kilbaugh, Children’s Hospital of Philadelphia, Philadelphia, PA; AM Iqbal O’Meara, Children’s Hospital of Richmond, Richmond, VA; Nathan Dean, Children’s National Medical Center, Washington, DC; Ranjit S. Chima, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Katherine Biagas, Columbia University, New York, NY; Enno Wildschut, Erasmus Medical Center, Rotterdam, Netherlands; Mark Peters, Great Ormond St Hospital NHS Foundation Trust, London, UK; Kerri LaRovere, Boston Children’s Hospital, Boston, MA; Joan Balcells, Hospital Vall d’Hebron, Barcelona, Spain; Courtney Robertson, John Hopkins University, Baltimore, MD; Shira Gertz, Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center, Hackensack, NJ; Akash Deep, King’s College Hospital NHS Foundation Trust, London, UK; Sian Cooper, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Mark Wainwright, Lurie Children’s Hospital, Chicago IL; Sarah Murphy, Massachusetts General Hospital, Boston, MA; John Kuluz, Miami Children’s Hospital, Miami, FL; Warwick Butt, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia; Nicole O’Brien, Nationwide Children’s Hospital, Columbus, OH; Neal Thomas, Pennsylvania State University, Hershey, PA; Sandra Buttram, Phoenix Children’s Hospital, Phoenix, AZ;

Simon Erickson, Princess Margaret Hospital, Perth, Australia; J. Mahil Samuel, Royal Manchester Children’s Hospital NHS Foundation Trust, Manchester, UK; Rachel Agbeko, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Richard Edwards, University Hospital Bristol NHS Foundation Trust, Bristol, UK; Kesava Ananth Ramakrishnan, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Santiago Borasino, University of Alabama at Birmingham, Birmingham, AL; Joanne Natale, University of California, Davis, Sacramento, CA; Christopher Giza, University of California, Los Angeles, Los Angeles, CA; David Shellington, University of California, San Diego, San Diego, CA; Anthony Figaji, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa; Elizabeth Newell, University of Iowa Children’s Hospital, Iowa City, IA; Edward Truemper, University of Nebraska Medical Center and Nebraska Medical Center, Omaha, NE; Robert Clark, University of Pittsburgh, Pittsburgh, PA; Kit Newth, Children’s Hospital of Los Angeles, Los Angeles, CA; Nadeem Shafi, LeBonheur Children’s Hospital, Memphis, TN; Darryl Miles, University of Texas Southwestern Medical Center, Dallas, TX; Michelle Schober, University of Utah, Jerry Zimmerman, University of Washington, Seattle, WA; Peter Ferrazzano, University of Wisconsin, Madison, WI; Jose Pineda, Washington University - St. Louis, St. Louis, MO; Ajit Sarnaik, Wayne State University, Detroit, MI.

Declaration Of Interest Statement

The authors declare no conflicts of interest.

Additional information

Funding

Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the US National Institute of Health under Award Number U01 NS081041. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke, the National Institute of Health or the US Department of Health and Human Services.