Multidisciplinary rehabilitation and follow-up for children hospitalized with traumatic brain injury
Lauren J Alessi1,2, Matthew MacCarthy3, Andrew McCormick4
1Division of Pediatric Critical Care Medicine, Helen DeVos Children's Hospital of Corewell Health, Grand Rapids, MI, USA.
Insights
Many children hospitalized with traumatic brain injury (TBI) have unmet rehabilitative needs post-discharge. Early, coordinated inpatient care and multidisciplinary follow-up are crucial for pediatric TBI recovery.
Area of Science:
- Pediatric neurology
- Rehabilitation medicine
- Neuroscience
Background:
- Traumatic brain injury (TBI) in children often leads to lasting impairments affecting function and quality of life.
- Current rehabilitative services for pediatric TBI lack standardization and consistent multidisciplinary, longitudinal care.
- Identifying unmet needs is critical for optimizing recovery trajectories in pediatric TBI survivors.
Purpose of the Study:
- To evaluate the rehabilitative services received during acute hospitalization for pediatric TBI.
- To determine the frequency of unmet needs, defined as new or untreated impairments, at the first acquired brain injury (ABI) clinic visit.
- To highlight the importance of coordinated, multidisciplinary care for children with TBI.
Main Methods:
- A single-center, retrospective study analyzing data from 148 children hospitalized for TBI.
- Patients were categorized by TBI severity (mild/complicated mild, moderate, severe).
- Unmet needs were assessed at a median of 63 days post-hospitalization during their initial ABI clinic visit.
Main Results:
- 55% of pediatric TBI patients presented with at least one unmet need at their initial ABI clinic assessment.
- Executive function and communication impairments were prevalent, even in mild TBI cases, with low rates of speech therapy (ST) utilization.
- Earlier consultation with physical therapy, occupational therapy, ST, and physiatry correlated with discharge home rather than inpatient rehabilitation (p < .05).
Conclusions:
- Timely inpatient rehabilitative care is essential for children following TBI.
- Longitudinal, multidisciplinary follow-up coordinated with acute care is vital for addressing unmet needs.
- Standardized, comprehensive rehabilitation strategies are needed to improve functional outcomes and quality of life for pediatric TBI survivors.
Abstract:
PurposeMost children hospitalized with traumatic brain injury (TBI) acquire new impairments that impact function and health-related quality of life. However, there is a lack of standardized, multidisciplinary, longitudinal rehabilitative services for children with TBI.MethodsThis single center, retrospective study evaluated rehabilitative services during acute hospitalization and identified the frequency of unmet needs, defined as new or untreated impairments at the first acquired brain injury (ABI) clinic visit.ResultsAnalysis was conducted for 148 children hospitalized for TBI (mild/complicated mild [51%], moderate [14%], or severe [35%]) and evaluated at ABI clinic (median of 63 [43-122] days post-hospitalization). Eighty-two (55%) patients had at least one unmet need at initial clinic assessment. Executive function impairments were found in children with mild/complicated mild TBI (32%), despite only 5% of them receiving speech therapy (ST) prior to the clinic. Only 13% of children with severe TBI received outpatient ST at first clinic visit despite 26% and 20% identified as having executive function and communication impairments. Earlier consultation of physical therapy, occupational therapy, ST, and physiatry was associated with discharge home versus inpatient rehabilitation, all p < .05.ConclusionThis study demonstrates the importance of timely inpatient acute hospital rehabilitative care coordinated with longitudinal, multidisciplinary follow-up for children after TBI.
