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

Greene, Nathaniel H

Kernic, Mary A

Vavilala, Monica S

Rivara, Frederick P

United States

2015-01-22T21:32:22Z

2014-06

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.

http://www.ncbi.nlm.nih.gov/pubmed/24631594

S0003-9993(14)00180-4

1532-821X

https://hdl.handle.net/10161/9372

eng

Elsevier BV

Arch Phys Med Rehabil

10.1016/j.apmr.2014.02.020

Healthcare disparities

Patient outcome assessment

Rehabilitation

Traumatic brain injury

Adolescent

Brain Injuries

Child

Child, Preschool

Cohort Studies

Databases, Factual

Female

Follow-Up Studies

Glasgow Coma Scale

Healthcare Disparities

Hospital Mortality

Hospitalization

Humans

Infant

Length of Stay

Linear Models

Male

Multivariate Analysis

Patient Transfer

Physical Therapy Modalities

Poisson Distribution

Rehabilitation Centers

Retrospective Studies

Risk Assessment

Socioeconomic Factors

Survival Rate

Time Factors

Treatment Outcome

United States

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

Journal article

Greene, Nathaniel H|0000-0003-0230-0499

http://www.ncbi.nlm.nih.gov/pubmed/24631594

1148

1155

6

Anesthesiology

Anesthesiology, Pediatrics

Clinical Science Departments

Duke

School of Medicine

Published

95