Effects of inpatient rehabilitation after acute care on functional and quality-of-life outcomes in children with severe traumatic brain injury.
Shiyao Gao, Amery Treble-Barna, Anthony Fabio and 5 others
PMID 36101488WHAT IT FOUND
Children with severe TBI and low consciousness scores at discharge who went to inpatient rehab had better global function at 12 months than those who did not.
No difference was found for those with higher consciousness scores or for quality of life.
Key findings
01In children with a Glasgow Coma Scale score below 13 at hospital discharge, receiving inpatient rehabilitation was associated with reduced odds of unfavorable global function at 12 months compared to non-inpatient rehabilitation.
02There was no significant association between rehabilitation type and global function for children with a GCS score of 13 or higher at discharge.
03No significant differences were found in health-related quality of life scores between the inpatient and non-inpatient rehabilitation groups.
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
Rehabilitation disposition was classified based on discharge destination from acute care, which may have led to misclassification if patients referred to inpatient rehab were not admitted, or if those discharged home were later admitted to inpatient facilities. The analysis of children with a GCS below 13 was underpowered due to the small sample size (n=84), resulting in wide confidence intervals. The study could not rule out residual confounding, as unmeasured factors may have influenced both the decision to admit to inpatient rehab and the patient outcomes. The GOS-E Peds scale provides a single composite score for global function, which may not capture subtle differences in specific impairments.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that inpatient rehabilitation is superior for all children with severe TBI. The benefit was only seen in the subgroup with a Glasgow Coma Scale score below 13 at discharge, and even then, the study was underpowered for this group. No benefit was found for children with higher consciousness scores or for quality-of-life outcomes.