Medical complications in children with central nervous system injuries during inpatient rehabilitation.

One hospital, 64 children and no comparison group: these numbers describe this centre's caseload and may not hold elsewhere. Only the rehabilitation physicians rated what each complication did to rehabilitation. They may not have known what happened in sessions run by physical, occupational or speech therapists, so consequences for those sessions may be missing. Seven different physicians did the ratings, and they may have judged the same situation differently. The post-discharge ratings relied on the physicians' memory of the stay, which can drift. No information was collected on what actually happened inside therapy sessions, so the link between a complication and a changed session is the physician's judgement rather than an observation. Children and parents were not asked about their experience of these complications. The study did not collect information on whether treating the complications helped. Children with complications stayed longer (median 55 days against 35 days for those without), but the paper states this does not show that complications cause longer stays; a more severely injured child may simply have both.

The authors declare no conflicts of interest. The work was funded by Sunnaas Rehabilitation Hospital, the hospital where the study was carried out.

Do not read the longer hospital stays as proof that complications cause them. Children who had complications stayed a median of 55 days against 35 days for those who did not, but the paper says it cannot tell whether complications lengthen the stay, whether longer stays produce complications such as hospital-acquired infection, or whether both simply reflect a more severely injured child.