CHOP Study Shows Severely Injured Children Need Continued Care After Rehabilitation

Most severely injured children experience improved cognitive function while they are in inpatient rehabilitation. However, researchers from The Children’s Hospital of Philadelphia have found that those with traumatic brain injury, or TBI, were discharged with significant cognitive functioning deficits affecting memory, problem solving, and verbal communication that would require continued support.

Mark Zonfrillo, MD, MSCE, and his fellow investigators analyzed the cognitive deficits of nearly 14,000 children (ages 7 to 18 years) 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 Dr. Zonfrillo, the senior researcher at the Center for Injury Research and Prevention and associate director of research in the Division of Emergency Medicine at CHOP. “These children may continue to improve after discharge, so this transition is a critical point in their care.”

Dr. Zonfrillo added that 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. Primary care providers, hospital rehabilitation staff, and parents therefore 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,” says 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 study was published in the Journal of Pediatrics.