Functional Independence After Inpatient Rehabilitation for Traumatic Brain Injury Among Minority Children and Adolescents

• Published in: Archives of physical medicine and rehabilitation Vol. 96; no. 7; pp. 1255 - 1261
• Main Authors: Jimenez, Nathalia, MD, MPH, Osorio, Marisa, DO, Ramos, Jessica L., BS, Apkon, Susan, MD, Ebel, Beth E., MD, MSc, MPH, Rivara, Frederick P., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2015
• Subjects: Adolescent; Age Factors; Black or African American - statistics & numerical data; Brain injuries; Brain Injuries - rehabilitation; Child; Child, Preschool; Cognition; Ethnicity - statistics & numerical data; Female; Health Status; Hispanic or Latino - statistics & numerical data; Humans; Infant; Inpatients; Male; Medicaid - statistics & numerical data; Minority groups; Minority Groups - statistics & numerical data; Outcome; Physical Medicine and Rehabilitation; Racial Groups - statistics & numerical data; Recovery of Function; Rehabilitation; Rehabilitation Centers - statistics & numerical data; Retrospective Studies; United States; White People - statistics & numerical data; United States; UDSMR; non-Hispanic black; CI; non-Hispanic white; traumatic brain injury; NHB; Minority groups; Brain injuries; DFQ; developmental functional quotient; Outcome; confidence interval; TBI; Rehabilitation; NHW; Uniform Data System for Medical Rehabilitation
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2015.02.019

Abstract Objective To compare motor and cognitive functional independence scores between Hispanic, non-Hispanic black (NHB), and non-Hispanic white (NHW) children with traumatic brain injury (TBI) after discharge from inpatient rehabilitation. Design Retrospective cohort study using the Uniform Data System for Medical Rehabilitation national dataset from the years 2002 to 2012. Setting Inpatient rehabilitation units. Participants Children (N=10,141) aged 6 months to 18 years who received inpatient rehabilitation for TBI. Interventions Not applicable. Main Outcome Measures Motor and cognitive functional independence after discharge from inpatient rehabilitation, adjusting for age, sex, admission function, length of stay, insurance, and region. Results Inpatient rehabilitation therapy improved functional independence for all children. Younger age, lower admission functional independence scores, and Medicaid insurance were associated with lower functional independence at discharge. Hispanic and NHB children had lower discharge cognitive scores compared with NHW children; however, differences were small and were partially explained by insurance status and region. Children who received rehabilitation therapy at pediatric facilities had greater cognitive improvement. Conclusions While racial/ethnic disparities are small, minority children are more likely to be younger, to have Medicaid, and to be cared for at nonpediatric facilities, factors that increase their risk for lower functional outcomes.