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Referral Patterns as a Contextual Variable in Pediatric Brain Injury: A Retrospective Analysis
Angela Hein Ciccia1, Jennifer P Lundine2, Alyssa Coreno1
1Case Western Reserve University, Cleveland, OH.
Insights
Pediatric brain injury rehabilitation is hindered by poor access to speech-language pathology (SLP) services. Early referrals for SLP are less likely for children with mild or unknown injury severity, impacting long-term outcomes.
Area of Science:
- Pediatric neurology
- Rehabilitation medicine
- Speech-language pathology
Background:
- Access to speech-language pathology (SLP) services is crucial for pediatric brain injury rehabilitation.
- Understanding referral patterns in the acute phase is essential for optimizing care.
Purpose of the Study:
- To examine speech-language pathology (SLP) referral patterns in the acute period following pediatric brain injury.
- To identify factors influencing SLP referrals in two large pediatric specialty hospitals.
Main Methods:
- Retrospective cohort chart review of 200 pediatric brain injury cases (2007-2014).
- Data extraction included demographics, injury characteristics, and rehabilitation referrals.
- Analysis focused on International Classification of Diseases, Ninth Revision, Clinical Modification codes.
Main Results:
- Significant disparity in SLP referral rates between hospitals (36% vs. 2%).
- Lower likelihood of SLP referral for children with unknown or mild injury severity.
- Younger age was also associated with reduced SLP referral rates.
Conclusions:
- Early acute period SLP referral rates for pediatric brain injury are inadequate.
- Poor referral access creates barriers to essential rehabilitation services.
- This can lead to broader, long-term negative impacts on child development and recovery.
Purpose:
Access to speech-language pathology (SLP) services is a critical variable in the rehabilitation of pediatric brain injury. In this study, we examined patterns of SLP referral and factors affecting referral during the acute period following brain injury in 2 large pediatric specialty hospitals.
Method:
In a retrospective, cohort chart review study, data collection focused on referrals made during the acute period using International Classification of Diseases, Ninth Revision, Clinical Modification codes for primary diagnoses of brain injury between 2007 and 2014 (Centers for Disease Control and Prevention [CDC], 2014). A total of 200 charts were reviewed. Data extraction included demographic and injury-related variables, referral for rehabilitation across disciplines, and plans of care following assessment.
Results:
Samples for both facilities were similar except for primary mechanism of traumatic brain injuries and severity. SLP referral rate at Hospital 1 was 36% and only 2% at Hospital 2. Regression revealed that individuals were less likely to receive an SLP referral if injury severity was classified as unknown or mild or if they were younger in age.
Conclusion:
SLP referral rates in the early acute period for children with brain injury were poor, creating a barrier to rehabilitation. This not only limits access to SLP services, but also may have broader and long-term impact.
