Association Between Facility Type During Pediatric Inpatient Rehabilitation and Functional Outcomes.
Molly M Fuentes, Susan Apkon, Nathalia Jimenez and 1 others
PMID 27026580WHAT IT FOUND
Children treated at children’s hospital rehabilitation units had shorter stays and gained function faster than those at other facilities.
After adjusting for illness severity, they ended with only 2.3 more cognitive points. This difference is likely too small to matter clinically.
Key findings
01Children treated at children’s hospital rehabilitation units had a median length of stay of 16 days, compared with 22 days at other facility types.
02After adjusting for demographics and impairment, children at children’s hospitals had discharge cognitive scores that were 2.3 points higher on the developmental functional quotient.
03The authors state that a difference of 2.3 developmental functional quotient points is unlikely to be clinically meaningful.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This is an observational study, not a randomized trial, so it cannot prove that the facility type caused the better outcomes. Children who went to children’s hospitals might have had different types of injuries or support systems that were not fully accounted for. Facility type was self-reported by the hospitals. Some freestanding rehabilitation hospitals have pediatric-specific units but were counted as 'other facilities,' which may have diluted the difference between the two groups. The study only included facilities that use the WeeFIM and submit data to the UDSMR, which may not represent all rehabilitation centers, particularly in the Northeast. There was no information on the child's functional level before the event that led to hospitalization, making it difficult to know the true starting baseline. The authors admit that the 2.3-point difference in cognitive scores is likely too small to be noticed by patients or families in daily life.
Declared interests
Two of the authors practice at a children’s hospital-based rehabilitation unit, which is the intervention being studied. The other authors have nothing to disclose.
The easy way to misread this
Do not assume that referring a child to a children’s hospital will result in a dramatically better functional outcome. The study found a statistically significant but clinically small difference of 2.3 cognitive points, and the authors explicitly state this is unlikely to be meaningful.