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Variation in pediatric traumatic brain injury outcomes in the United States.

dc.contributor.author Greene, Nathaniel H
dc.contributor.author Kernic, Mary A
dc.contributor.author Vavilala, Monica S
dc.contributor.author Rivara, Frederick P
dc.coverage.spatial United States
dc.date.accessioned 2015-01-22T21:32:22Z
dc.date.issued 2014-06
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/24631594
dc.identifier S0003-9993(14)00180-4
dc.identifier.uri https://hdl.handle.net/10161/9372
dc.description.abstract OBJECTIVE: To ascertain the degree of variation, by state of hospitalization, in outcomes associated with traumatic brain injury (TBI) in a pediatric population. DESIGN: A retrospective cohort study of pediatric patients admitted to a hospital with a TBI. SETTING: Hospitals from states in the United States that voluntarily participate in the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. PARTICIPANTS: Pediatric (age ≤ 19 y) patients hospitalized for TBI (N=71,476) in the United States during 2001, 2004, 2007, and 2010. INTERVENTIONS: None. 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 3-fold among the states, and the relative risk of inpatient mortality varied by as much as nearly 2-fold. In the United States, approximately 1981 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.
dc.language eng
dc.publisher Elsevier BV
dc.relation.ispartof Arch Phys Med Rehabil
dc.relation.isversionof 10.1016/j.apmr.2014.02.020
dc.subject Healthcare disparities
dc.subject Patient outcome assessment
dc.subject Rehabilitation
dc.subject Traumatic brain injury
dc.subject Adolescent
dc.subject Brain Injuries
dc.subject Child
dc.subject Child, Preschool
dc.subject Cohort Studies
dc.subject Databases, Factual
dc.subject Female
dc.subject Follow-Up Studies
dc.subject Glasgow Coma Scale
dc.subject Healthcare Disparities
dc.subject Hospital Mortality
dc.subject Hospitalization
dc.subject Humans
dc.subject Infant
dc.subject Length of Stay
dc.subject Linear Models
dc.subject Male
dc.subject Multivariate Analysis
dc.subject Patient Transfer
dc.subject Physical Therapy Modalities
dc.subject Poisson Distribution
dc.subject Rehabilitation Centers
dc.subject Retrospective Studies
dc.subject Risk Assessment
dc.subject Socioeconomic Factors
dc.subject Survival Rate
dc.subject Time Factors
dc.subject Treatment Outcome
dc.subject United States
dc.title Variation in pediatric traumatic brain injury outcomes in the United States.
dc.type Journal article
duke.contributor.id Greene, Nathaniel H|0374911
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/24631594
pubs.begin-page 1148
pubs.end-page 1155
pubs.issue 6
pubs.organisational-group Anesthesiology
pubs.organisational-group Anesthesiology, Pediatrics
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group School of Medicine
pubs.publication-status Published
pubs.volume 95
dc.identifier.eissn 1532-821X
duke.contributor.orcid Greene, Nathaniel H|0000-0003-0230-0499


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