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Initiation of physical, occupational, and speech therapy in children with traumatic brain injury
Tellen D Bennett1, Christian M Niedzwecki, E Kent Korgenski
1Pediatric Critical Care, University of Utah School of Medicine, Salt Lake City, UT 84158, USA. tell.bennett@hsc.utah.edu
Insights
Hospitalized children with traumatic brain injury (TBI) show significant variation in receiving physical/occupational and speech/swallow therapy evaluations, with older age and injury severity being key factors. Standardized criteria are needed to ensure equitable care.
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Traumatology
Background:
- Traumatic brain injury (TBI) in children can lead to significant functional impairments.
- Early and appropriate rehabilitation interventions are crucial for recovery.
- Current practices for initiating therapy evaluations in pediatric TBI populations are not well-defined.
Purpose of the Study:
- To identify factors influencing physical therapy (PT), occupational therapy (OT), and speech/swallow therapy evaluations for hospitalized children with TBI.
- To describe the timing of initial therapy evaluations during hospitalization.
- To quantify inter-hospital variability in the provision of these therapy services.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System database (2001-2011).
- Included children (<18 years) with TBI admitted to the intensive care unit and surviving to discharge (N=21,399).
- Analyzed PT/OT and speech/swallow evaluations using propensity score methods to compare expected vs. observed rates.
Main Results:
- Only 41% received PT/OT evaluation and 26% received speech/swallow evaluation.
- Older children, those with higher injury severity, and those treated at Level I pediatric trauma centers were more likely to receive evaluations.
- Median time to first evaluation was 5 days for PT/OT and 7 days for speech/swallow.
- Observed therapy evaluation rates varied widely across hospitals (PT/OT: 11%-74%; Speech/Swallow: 4%-55%).
Conclusions:
- Significant between-hospital disparities exist in providing rehabilitation therapies for pediatric TBI patients.
- There is a critical need for evidence-based guidelines to standardize the initiation of therapy evaluations following pediatric TBI.
- Optimizing therapy access can improve outcomes for children with TBI.
Objectives:
(1) To determine factors associated with physical therapy (PT) or occupational therapy (OT) evaluation and speech or swallow therapy evaluation in hospitalized children with traumatic brain injury (TBI); (2) to describe when during the hospital stay the initial therapy evaluations typically occur; and (3) to quantify any between-hospital variation in therapy evaluation.
Design:
Retrospective cohort study.
Setting:
Children's hospitals participating in the Pediatric Health Information System database (January 2001-June 2011).
Participants:
Children (age <18y) with TBI (N=21,399) who were admitted to the intensive care unit and survived to hospital discharge.
Interventions:
Not applicable.
Main Outcome Measures:
PT or OT evaluation and speech or swallow therapy evaluation. A propensity score was calculated to allow comparison of expected with observed rates of therapy evaluations by the hospital.
Results:
The median hospital length of stay was 5 days (interquartile range, 3-10d). Overall, 8748 (41%) of 21,399 children received either a PT or OT evaluation, and 5490 (26%) out of 21,399 children received either a speech or swallow evaluation. Older children and those with higher energy injury mechanisms, more severe injuries, extremity fractures, more treatment with neuromuscular blocking agents or pentobarbital, and admission to a hospital with an American College of Surgeons Level I pediatric trauma designation were more likely to receive therapy evaluations. The median time until the first therapy evaluation was 5 (PT or OT) and 7 days (speech or swallow). Expected hospital evaluation rates were 25% to 54% (PT or OT) and 16% to 35% (speech or swallow), while observed hospital evaluation rates were 11% to 74% (PT or OT) and 4% to 55% (speech or swallow).
Conclusions:
There is wide between-hospital variation in provision of rehabilitation therapies for children with TBI. Evidence-based criteria for initiation of routine therapy evaluations after TBI are needed.
