Mark R Zonfrillo1, Dennis R Durbin2, Flaura K Winston3, Xuemei Zhang4, Margaret G Stineman5. 1. Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: Zonfrillo@email.chop.edu. 2. Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 3. Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA. 4. Biostatistics and Data Management Core, The Children's Hospital of Philadelphia, Philadelphia, PA. 5. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Abstract
OBJECTIVE: To determine the prevalence and nature of residual cognitive disability after inpatient rehabilitation for children aged 7-18 years with traumatic injuries. STUDY DESIGN: This retrospective cohort study included children aged 7-18 years in the Uniform Data System for Medical Rehabilitation who underwent inpatient rehabilitation for traumatic injuries in 523 facilities from 2002-2011. Traumatic injuries were identified by standardized Medicare Inpatient Rehabilitation Facility-Patient Assessment Instrument codes. Cognitive outcomes were measured by the Functional Independence Measure instrument. A validated, categorical staging system derived from responses to the items in the cognitive domain of the functional independence measure was used and consisted of clinically relevant levels of cognitive achievement from stage 1 (total cognitive disability) to stage 7 (completely independent cognitive function). RESULTS: There were 13,798 injured children who completed inpatient rehabilitation during the 10-year period. On admission to inpatient rehabilitation, patients with traumatic brain injury (TBI) had more cognitive disability (median stage 2) than those with spinal cord injury or other injuries (median stage 5). Cognitive functioning improved for all patients, but children with TBI still tended to have significant residual cognitive disability (median stage on discharge, 4). CONCLUSIONS: Injured children gained cognitive functionality throughout inpatient rehabilitation. Those with TBI had more severe cognitive disability on admission and more residual disability on discharge. This is important not only for patient and family expectation setting but also for resource and service planning, as discharge from inpatient rehabilitation is a critical milestone for reintegration into society for children with serious injury.
OBJECTIVE: To determine the prevalence and nature of residual cognitive disability after inpatient rehabilitation for children aged 7-18 years with traumatic injuries. STUDY DESIGN: This retrospective cohort study included children aged 7-18 years in the Uniform Data System for Medical Rehabilitation who underwent inpatient rehabilitation for traumatic injuries in 523 facilities from 2002-2011. Traumatic injuries were identified by standardized Medicare Inpatient Rehabilitation Facility-Patient Assessment Instrument codes. Cognitive outcomes were measured by the Functional Independence Measure instrument. A validated, categorical staging system derived from responses to the items in the cognitive domain of the functional independence measure was used and consisted of clinically relevant levels of cognitive achievement from stage 1 (total cognitive disability) to stage 7 (completely independent cognitive function). RESULTS: There were 13,798 injured children who completed inpatient rehabilitation during the 10-year period. On admission to inpatient rehabilitation, patients with traumatic brain injury (TBI) had more cognitive disability (median stage 2) than those with spinal cord injury or other injuries (median stage 5). Cognitive functioning improved for all patients, but children with TBI still tended to have significant residual cognitive disability (median stage on discharge, 4). CONCLUSIONS: Injured children gained cognitive functionality throughout inpatient rehabilitation. Those with TBI had more severe cognitive disability on admission and more residual disability on discharge. This is important not only for patient and family expectation setting but also for resource and service planning, as discharge from inpatient rehabilitation is a critical milestone for reintegration into society for children with serious injury.
Authors: Margaret G Stineman; Richard N Ross; Roger Fiedler; Carl V Granger; Greg Maislin Journal: Arch Phys Med Rehabil Date: 2003-01 Impact factor: 3.966
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Authors: Mark R Zonfrillo; Isabella Zaniletti; Matthew Hall; Evan S Fieldston; Jeffrey D Colvin; Jessica L Bettenhausen; Michelle L Macy; Elizabeth R Alpern; Gretchen J Cutler; Jean L Raphael; Rustin B Morse; Marion R Sills; Samir S Shah Journal: J Pediatr Date: 2015-11-10 Impact factor: 4.406
Authors: Eric T Caliendo; Nayoung Kim; David Edasery; Gulce Askin; Sophie Nowak; Linda M Gerber; Katherine T Baum; Laura S Blackwell; Christine H Koterba; Kristen R Hoskinson; Brad G Kurowski; Matthew McLaughlin; Sarah J Tlustos; William D Watson; Sumit N Niogi; Stacy J Suskauer; Sudhin A Shah Journal: J Neurotrauma Date: 2021-03-01 Impact factor: 4.869