November 2013

Injured Children Need Continued Care Following Rehabilitation

rehabilitation

A new Children’s Hospital study found that while most children improved cognitive function while in inpatient rehabilitation, those with traumatic brain injury (TBI) were discharged with significant cognitive functioning deficits affecting memory, problem solving, and verbal communication that would require continued support. Researchers recommend that parents and their child’s primary care physician coordinate reentry to home and school.

The study, published in the Journal of Pediatrics, analyzed the cognitive deficits of nearly 14,000 children ages 7 to 18 years from 2002-2011, before and after admission to inpatient rehabilitation for trauma-related injuries. Children with TBI had more cognitive disability when entering inpatient rehab than other seriously injured children, including those with spinal cord injury, multiple fractures/amputation, and burns. While all injury groups showed improvements upon discharge, the TBI group had severe cognitive disability upon admission, and improved to only moderate disability upon discharge.

“At discharge, children with moderate cognitive disability can usually communicate and express needs but may need prompting for problem solving and memory,” said the study’s leader, Mark Zonfrillo, MD, MSCE, an investigator at the Center for Injury Research and Prevention (CIRP) and associate director of research in the Division of Emergency Medicine. “These children may continue to improve after discharge, so this transition is a critical point in their care.” In addition to Dr. Zonfrillo, CIRP’s Dennis Durbin, MD, MSCE, and Flaura K. Winston, MD, PhD, also contributed to the investigation.

A previous study led by Dr. Zonfrillo, published last year in Pediatrics, assessed physical disabilities for this same group of children. That study also demonstrated improvements throughout rehabilitation, but children with spinal cord injuries had longer lengths of stays and more physical disability at discharge. Even though many of these children improved functionally, they still required assistance for day-to-day tasks.

According to Dr. Zonfrillo, while primary care providers do not care for these children in the hospital ICU or during inpatient rehabilitation, they are responsible for a patient’s ongoing holistic care. Thus primary care providers, rehabilitation staff, and parents need to communicate with each other during this transition period. Additionally, many states have programs and services that can help these efforts, including brain injury associations and organizations.

“There is a concern that socioeconomically disadvantaged families may have additional challenges with their child reentering society,” said Dr. Zonfrillo. “Some families may not have the social support or economic means to know how to help their child after returning home, and they need to know that their child’s primary care provider can coordinate access to the resources they need.”

The researchers next plan to look at the demographics of serious pediatric injury recovery, including which specific injuries cause the most long-term care needs and which groups have better health outcomes for these specific injuries. Factors to be analyzed include sex, socioeconomic status, insurance, race, access to care, and injury severity.

“The goal of this line of research at CHOP is to maximize access to trauma systems and to optimize acute and rehabilitation care for young patients with serious injuries,” said Dr. Zonfrillo. “If we have a complete picture of the scale of pediatric traumatic injuries and related long-term needs, as well as the differences between injury patterns and various outcomes, we can predict the type and level of support necessary upon discharge from inpatient rehabilitation.”

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