Research Reports - Rehabilitation following pediatric traumatic brain injury

J Head Trauma Rehabil. 2013 Jul 3

Ennis SK, Jaffe KM, Mangione-Smith R, Konodi MA, Mackenzie EJ, Rivara FP

OBJECTIVE:: To examine variations in processes of pediatric inpatient
rehabilitation care related to family-centered care, management of
neurobehavioral and psychosocial needs, and community reintegration after
traumatic brain injury.
SETTING:: Nine acute rehabilitation facilities from geographically diverse areas
of the United States.
PARTICIPANTS:: A total of 174 children with traumatic brain injury.
DESIGN:: Retrospective chart review.
MAIN MEASURES:: Adherence to care indicators (the number of times recommended
care was delivered or attempted divided by the number of times care was
indicated).
RESULTS:: Across facilities, adherence rates (adjusted for difficulty of
delivery) ranged from 33.6% to 73.1% (95% confidence interval, 13.4-53.9,
58.7-87.4) for family-centered processes, 21.3% to 82.5% (95% confidence
interval, 6.6-36.1, 67.6-97.4) for neurobehavioral and psychosocial processes,
and 22.7% to 80.3% (95% confidence interval, 5.3-40.1, 68.1-92.5) for community
integration processes. Within facilities, standard deviations for adherence rates
were large (24.3-34.9, family-centered domain; 22.6-34.2, neurobehavioral and
psychosocial domain; and 21.6-40.5, community reintegration domain).
CONCLUSION:: The current state of acute rehabilitation care for children with
traumatic brain injury is variable across different quality-of-care indicators
addressing neurobehavioral and psychosocial needs and facilitating community
reintegration of the patient and the family. Individual rehabilitation facilities
demonstrate inconsistent adherence to different indicators and inconsistent
performance across different care domains.

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