Children Hospitalized for Traumatic Brain Injury: Transition to Postacute Care

Abstract

Objectives: To document causes, course of acute care, and outcomes in a large sample of children and adolescents (N=24,021) hospitalized for traumatic brain injury. Special focus is given to patterns of referral to rehabilitation and educational services at the time of discharge from acute care. Design: Descriptive statistics applied to a multicenter data collection on pediatric trauma. Setting: Seventy-six pediatric trauma centers or children's hospitals in the United States that reported to the National Pediatric Trauma Registry between October 1988 and April 1996. Data Set: Demographics, cause of injury, time and place of occurrence, severity of injury, utilization of resources during acute care, in hospital death rate, functional limitations, discharge disposition, and discharge recommendation for children who sustained a traumatic brain injury associated or not with injury to other body region. Results: Two thirds of the children were male and 77.8% were one to 14 years of age. Injuries occurred mostly between noon and midnight (67.7%) and on the road (50.0%) or at home (32.0%). Nearly all injuries (90%) were unintentional, most children (63.6%) sustained injuries to other body regions, and the anatomical severity of the injuries was ten times higher than in children without traumatic brain injury. Over A0% of the children were in the intensive care unit, 20% had one or more surgical intervention, the average length of stay was six days, the median two days. The in hospital death rate was 6.1% and 22.2% of the children developed functional limitations from the injury. At the time of discharge from acute care, most children returned home. In the group with four to nine limitations, half of the children were discharged to a rehabilitation facility. Of the children with functional limitations who returned home, physical therapy was recommended In 23.7% of the cases, occupational therapy in 13.2% of the cases, and speech therapy in 10.1% of the cases. Of those of school age discharged home with functional limitations, 1.8% were referred to special education. Conclusion: The majority of children with traumatic brain injury and functional limitations due to the injury return home at time of discharge from acute care with limited referral to potentially beneficial services. To correct these deficiencies, more research is needed to identify nonmedical factors affecting referrals.