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Requirements for Rehabilitation Services for Children after Severe Acquired Brain Injury
F Caulfield1, S Finn2,3, I Gill1,4
1Department of Neurodisability, Children's Health Ireland at Temple Street, Dublin, Ireland.
Insights
Severe acquired brain injury (ABI) in children is a significant cause of disability. This study found an average of 47 cases annually in Ireland, highlighting an urgent need for improved pediatric rehabilitation services.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Public Health
Background:
- Acquired brain injury (ABI) is a leading cause of acquired disability in children.
- Rehabilitation services for pediatric ABI are notably underdeveloped in Ireland.
- Estimating the incidence of severe ABI in young people is crucial for service planning.
Purpose of the Study:
- To estimate the incidence of severe acquired brain injury (ABI) requiring rehabilitation in young people in Ireland.
- To analyze the characteristics of these injuries and subsequent hospital admissions.
- To identify gaps in current rehabilitation service provision.
Main Methods:
- Analysis of the National Quality Assurance and Information System (NQAIS) database.
- Identification of patients aged 1-16 years with probable severe acquired brain injury requiring rehabilitation (PSABIR) between 2016-2019.
- PSABIR defined as a likely ABI cause combined with hospital admission >28 days.
Main Results:
- 187 young people experienced PSABIRs from 2016-2019, representing 4.55 per 100,000 annually.
- The median hospital stay was 46 days, with 70.6% discharged directly home.
- Only 1% of children were discharged to specialist rehabilitation services.
Conclusions:
- Severe ABI constitutes a significant portion of prolonged pediatric hospital admissions in Ireland.
- Most children with severe ABI spend their acute recovery in tertiary hospitals before returning home.
- There is a critical need to develop comprehensive rehabilitation services across all care settings to meet the needs of these young patients.
Abstract:
Aim Acquired brain injury (ABI) is a common cause of acquired disability in children. Rehabilitation services are known to be underdeveloped in Ireland. We aimed to estimate the incidence of severe ABI in young people in Ireland. Methods The National Quality Assurance and Information System (NQAIS) database was analysed to identify patients aged 1-16 years who had suffered a "probable severe acquired brain injury requiring rehabilitation" (PSABIR) from 2016 - 2019. PSABIR is defined as the co-occurrence of a medical condition likely to cause ABI with a length of hospital admission longer than 28 days. Results 187 young people in Ireland had PSABIRs from 2016-2019, accounting for 21.4% of all prolonged admissions (incidence 4.55 per 100,000 per year). Median length of stay was 46 days (IQR 35- 80 days). Two children (1%) were discharged directly to specialist rehabilitation; 132 (70.6%) were discharged directly home. Conclusion Severe ABI accounts for a significant proportion of prolonged paediatric admissions, with an average of 47 such events per year. Most young people spend the acute and subacute phases of recovery in a tertiary acute hospital, before being discharged directly home. Rehabilitation services need to be developed in all settings to address unmet need.
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