Post-discharge rehabilitation and functional recovery after pediatric injury. Issue 8 (August 2022)

• Record Type: Journal Article
• Authors: Maddux, Aline B.; VanBuren, John M.; Jensen, Aaron R.; Holubkov, Richard; Alvey, Jessica S.; McQuillen, Patrick; Mourani, Peter M.; Meert, Kathleen L; Burd, Randall S.
• Is Part Of: Injury. Volume 53:Issue 8(2022)
• Page Start: 2795
• Page End: 2803
• Publication Date: 2022-08
• Subjects: Pediatrics -- Wounds and injury -- Critical care -- Brain injuries -- Traumatic -- Critical care outcomes -- Patient outcome assessment -- Functional status -- Rehabilitation -- Follow-up studies -- Morbidity; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2022.05.023
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Discharge functional impairment and injury characteristics were most strongly associated with disposition to inpatient rehabilitation. Injury characteristics and insurance status were most strongly associated with disposition with outpatient rehabilitation. Children discharged with outpatient rehabilitation commonly had motor impairments, most that improved after discharge. Children discharged to inpatient rehabilitation had multi-domain impairments, many that improved after discharge. Abstract: Introduction: Variability in rehabilitation disposition has been proposed as a trauma center quality metric. Benchmarking rehabilitation disposition is limited by a lack of objective measures of functional impairment at discharge. The primary aim of this study was to determine the relative contribution of patient characteristics and hospitalization factors associated with inpatient and outpatient rehabilitation after discharge. The secondary aims were to evaluate the sensitivity of the Functional Status Scale (FSS) score for identifying functional impairments at hospital discharge and track post-discharge recovery. Patients and methods: We report a planned secondary analysis of a prospective observational study of seriously injured children (<15 years old) enrolled at seven pediatric trauma centers. Functional Status Scale (FSS) score was measured for pre-injury, hospital discharge, and 6-month follow-up timepoints. Multinomial logistic regression identified factors associated with three dispositions: home without rehabilitation services, home with outpatient rehabilitation, and inpatient rehabilitation. Relative weight analysis was used to identify the impact of individual factors associated with inpatient or outpatient rehabilitation disposition. Results: We analyzed 427 children with serious injuries. Functional impairment at discharge was present in 103 (24.1%) children, including 43/337 (12.8%) discharged without services, 12/38 (31.6%) discharged with outpatient rehabilitation, and 44/47 (93.6%) discharged to inpatient rehabilitation. In multivariable modeling, variables most contributing to prediction of inpatient rehabilitation were severe initial Glasgow coma scale (GCS), injured body region, and functional impairment at discharge. Severe initial GCS, private insurance, and extremity injury were independently associated with disposition with outpatient rehabilitation. Patients discharged without services or with outpatient rehabilitation most frequently had motor impairments that improved during the next 6 months. Patients discharged to inpatient rehabilitation had impairments in all domains, with many improving within 6 months. A higher proportion of patients discharged to inpatient rehabilitation had residual impairments at follow-up. Conclusion: Injury characteristics and discharge impairment were associated with discharge to inpatient rehabilitation. The FSS score identified impairments needing inpatient rehabilitation and characterized improvements after discharge. Less severe impairments needing outpatient rehabilitation were not identified by the FSS score.