Multidisciplinary rehabilitation and follow-up for children hospitalized with traumatic brain injury.
Lauren J Alessi, Matthew MacCarthy, Andrew McCormick and 6 others
PMID 40765299WHAT IT FOUND
Over half of children hospitalized with traumatic brain injury had new functional impairments requiring fresh referrals at their first follow-up clinic.
Earlier inpatient therapy consultations were associated with discharge to home, but this was a single-center observational study.
Key findings
01Unmet needs were identified in 55% of children at their first post-discharge clinic visit, with the most common new referrals being for speech therapy (43%) and neuropsychology (54%).
02In the entire cohort, fewer days to receive acute hospital consultations for physical, occupational, and speech therapy were each associated with discharge to home rather than inpatient rehabilitation.
03Executive function and communication were the most common functional impairments identified both at acute hospital discharge and at the first follow-up clinic visit.
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 study was a single-center retrospective chart review, and the analyzed cohort represented less than 10% of all pediatric TBI admissions at the center, introducing significant selection bias. Children with uncomplicated mild TBI were excluded as they were referred to a separate concussion clinic, limiting generalizability to the broader TBI population. The association between earlier therapy and home discharge is observational; sicker children or those with more severe injuries may naturally receive later consults or require inpatient rehab, meaning the therapy itself may not have caused the home discharge. In the sub-analysis of only PICU patients, the association between time to therapy and discharge disposition disappeared, suggesting the findings may be driven by the milder end of the cohort or confounding by severity. No routine validated measures were used to determine the need for referral; decisions were based on clinical judgment, which introduces subjectivity.
Declared interests
The authors reported no financial support for the research, authorship, or publication. Specific NIH grants were acknowledged for other work but not this study, and no potential conflicts of interest were declared.
The easy way to misread this
Do not interpret the association between earlier therapy consultation and home discharge as proof that faster therapy causes better discharge outcomes. The study is observational, and children who were well enough to go home may have simply been referred to therapy earlier than those who required inpatient rehabilitation.
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