Unmet Rehabilitation Needs After Hospitalization for Traumatic Brain Injury

Author:

Fuentes Molly M.12,Wang Jin23,Haarbauer-Krupa Juliet4,Yeates Keith Owen5,Durbin Dennis678,Zonfrillo Mark R.910,Jaffe Kenneth M.123,Temkin Nancy211,Tulsky David121314,Bertisch Hilary15,Rivara Frederick P.2316

Affiliation:

1. Departments of Rehabilitation Medicine,

2. The Harborview Injury Prevention and Research Center, Seattle, Washington;

3. Pediatrics,

4. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia;

5. Department of Psychology, University of Calgary, Hotchkiss Brain Institute, and Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada;

6. Division of Emergency Medicine and

7. Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;

8. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;

9. Departments of Pediatrics and

10. Emergency Medicine, Hasbro Children’s Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode Island;

11. Neurological Surgery and Biostatistics, University of Washington, Seattle, Washington;

12. Departments of Physical Therapy and

13. Psychological and Brain Sciences and

14. Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware; and

15. Rusk Rehabilitation, School of Medicine, New York University, New York, New York

16. Epidemiology, and

Abstract

OBJECTIVES: In this study, we describe unmet service needs of children hospitalized for traumatic brain injury (TBI) during the first 2 years after injury and examine associations between child, family, and injury-related characteristics and unmet needs in 6 domains (physical therapy, occupational therapy, speech therapy, mental health services, educational services, and physiatry). METHODS: Prospective cohort study of children age 8 to 18 years old admitted to 6 hospitals with complicated mild or moderate to severe TBI. Service need was based on dysfunction identified via parent-report compared with retrospective baseline at 6, 12, and 24 months. Needs were considered unmet if the child had no therapy services in the previous 4 weeks, no physiatry services since the previous assessment, or no educational services since injury. Analyses were used to compare met and unmet needs for each domain and time point. Generalized multinomial logit models with robust SEs were used to assess factors associated with change in need from pre-injury baseline to each study time point. RESULTS: Unmet need varied by injury severity, time since injury, and service domain. Unmet need was highest for physiatry, educational services, and speech therapy. Among children with service needs, increased time after TBI and complicated mild TBI were associated with a higher likelihood of unmet rather than met service needs. CONCLUSIONS: Children hospitalized for TBI have persistent dysfunction with unmet needs across multiple domains. After initial hospitalization, children with TBI should be monitored for functional impairments to improve identification and fulfillment of service needs.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

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