Research Reports - Variation in pediatric traumatic brain injury outcomes in the United States
Arch Phys Med Rehabil. 2014 Mar 10
Greene NH(1), Kernic MA(2), Vavilala MS(3), Rivara FP(4)
OBJECTIVE: To ascertain the degree of variation, by state of hospitalization, in
outcomes associated with traumatic brain injury in a pediatric population.
DESIGN: A retrospective cohort study of pediatric patients admitted to a hospital
with a traumatic brain injury.
SETTING: Hospitals from states in the United States of America that voluntarily
participate in the Agency for Healthcare Research and Quality's Healthcare Cost
and Utilization Project.
PARTICIPANTS: Pediatric (≤19 years old) patients hospitalized for traumatic brain
injury (n=71,476) in the United States during 2001, 2004, 2007, and 2010.
MAIN OUTCOME MEASURES: Primary outcome was proportion of patients discharged to
rehabilitation after an acute care hospitalization among alive discharges. The
secondary outcome was inpatient mortality.
RESULTS: The relative risk of discharge to inpatient rehabilitation varied by as
much as three-fold among the states and the relative risk of inpatient mortality
varied by as much as nearly two-fold. In the United States, approximately 1,981
patients could be discharged to inpatient rehabilitation care if the observed
variation in outcomes was eliminated.
CONCLUSIONS: There was significant variation between states in both
rehabilitation discharge and inpatient mortality after adjusting for variables
known to affect each outcome. Future efforts should be focused on identifying the
cause of this state-to-state variation, its relationship to patient outcome, and
standardizing treatment across the United States.