Characteristics Associated with the Use of an Inpatient Rehabilitation or Skilled Nursing Facility after Acute Care in Children with Severe Traumatic Brain Injury.
Shiyao Gao, Anthony Fabio, Bedda L Rosario and 4 others
PMID 33872126WHAT IT FOUND
Children with severe TBI in the UK had 93% lower odds of inpatient rehabilitation than US peers.
Longer acute stays predicted home-based care. Younger children and African Americans in the US were less likely to be admitted to inpatient rehab, though these demographic findings were unadjusted.
Key findings
01Study region significantly influenced access, with UK children having 93% reduced odds of receiving inpatient rehabilitation compared to US children.
02Children who stayed in acute care hospitals for more than 23 days had 56% decreased odds of receiving inpatient rehabilitation compared to those with shorter stays.
03In the US cohort, children who received only non-inpatient rehabilitation were more likely to be younger and African American, though these associations were not adjusted for other factors.
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
The US cohort was too small to perform multivariable analysis, so demographic findings like race and age are unadjusted and may be confounded by other factors. Rehabilitation disposition was classified based on initial discharge destination, which may have misclassified children referred to but not admitted to inpatient facilities, or those admitted later. The study did not measure contextual factors like the availability of local rehabilitation resources or on-site units, which likely influenced the regional differences found. Family socioeconomic status measures were limited and did not include insurance type or income, making it difficult to fully understand the drivers of access disparities.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that the demographic disparities found in the US cohort, such as lower inpatient rehabilitation rates for younger or African American children, are independent causes. These findings were from unadjusted analyses in a small sample and may be confounded by injury severity or other clinical factors.