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The Use of Methylphenidate During Inpatient Rehabilitation After Pediatric Traumatic Brain Injury: Population
Eric Caliendo1, Ryan Lowder, Matthew J McLaughlin
1Department of Medicine, Emory University, Atlanta, Georgia (Dr Caliendo); David Geffen School of Medicine at UCLA, Los Angeles, California (Ms Lowder); Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, Missouri (Dr McLaughlin); University of Missouri-Kansas City School of Medicine (Dr McLaughlin); Blythedale Children's Hospital, Valhalla, New York (Dr Watson); Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York (Dr Watson); Department of Radiology, Weill Cornell Medicine, New York City, New York (Dr Shah); Department of Rehabilitation, Children's Hospital Colorado, Aurora (Dr Tlustos); Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Dr Tlustos); Department of Neuropsychology (Dr Koterba), and Center for Biobehavioral Health, Abigail Wexner Research Institute (Dr Hoskinson), Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus (Dr Koterba); Department of Pediatrics, The Ohio State University College of Medicine, Columbus (Dr Hoskinson); Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Kurowski); Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Kurowski); Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia (Dr Blackwell); Kennedy Krieger Institute, Baltimore, Maryland (Dr Suskauer); and Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Suskauer). Dr Baum is in private practice, Paoli, Pennsylvania.
Objective:
To understand how methylphenidate (MPH) is used in youth with traumatic brain injury (TBI) during inpatient pediatric rehabilitation.
Setting:
Inpatient pediatric rehabilitation.
Participants:
In total, 234 children with TBI; 62 of whom received MPH and 172 who did not. Patients were on average 11.6 years of age (range, 2 months to 21 years); 88 of 234 were female; the most common mechanism of injury was motor vehicle collision (49%); median (IQR) acute hospital length of stay (LOS) and inpatient rehabilitation LOS were 16 (10-29) and 23 (14-39), respectively; 51 of 234 were in a disorder of consciousness cognitive state at time of inpatient rehabilitation admission.
Design:
Multicenter, retrospective medical record review.
Main Measures:
Patient demographic data, time to inpatient pediatric rehabilitation admission (TTA), cognitive state, MPH dosing (mg/kg/day).
Results:
Patients who received MPH were older (P = .011); TTA was significantly longer in patients who received MPH than those who did not (P =.002). The lowest recorded dose range by weight was 0.05 to 0.89 mg/kg/d, representing an 18-fold difference; the weight-based range for the maximum dose was 0.11 to 0.97 mg/kg/d, a 9-fold difference. Patients in lower cognitive states at admission (P = .001) and at discharge (P = .030) were more likely to receive MPH. Five patients had side effects known to be associated with MPH; no serious adverse events were reported.
Conclusion:
This multicenter study indicates that there is variable use of MPH during acute inpatient rehabilitation for children with TBI. Children who receive MPH tend to be older with lower cognitive states. Dosing practices are likely consistent with underdosing. Clinical indications for MPH use during inpatient pediatric rehabilitation should be better defined. The use of MPH, as well as its combination with other medications and treatments, during inpatient rehabilitation needs to be further explored.
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