Variations in Utilization of Inpatient Rehabilitation Services among Pediatric Trauma Patients

• Published in: The Journal of pediatrics 2017-03, Vol.182, p.342-348.e1
• Main Authors: Nguyen, Huong T., BA, Newton, Christopher, MD, FACS, FAAP, Pirrotta, Elizabeth A., MS, Aguilar, Christine, MD, Wang, N. Ewen, MD
• Format: Article
• Language: English
• Subjects: Abbreviated Injury Scale; Adolescent; Age Factors; California; Case-Control Studies; Child; Child, Preschool; Cohort Studies; Female; Humans; Injury Severity Score; Inpatients - statistics & numerical data; Length of Stay; Logistic Models; Male; minority children; Multivariate Analysis; Patient Selection; payer status; Pediatrics; Prognosis; racial disparities; Registries; rehabilitation admission; Retrospective Studies; Risk Assessment; Sex Factors; Survival Rate; Trauma Centers; traumatic injury; Treatment Outcome; Wounds and Injuries - diagnosis; Wounds and Injuries - mortality; Wounds and Injuries - rehabilitation
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2016.11.039

Objective To assess clinical and nonclinical characteristics associated with the use of pediatric inpatient rehabilitation services among children with traumatic injuries. We hypothesized there would be no nonclinical variations in the use of pediatric inpatient rehabilitation services. Study design Retrospective analysis of 1139 patients who were injured seriously (0-18 years of age) from our institutional trauma registry (2004-2014). Patients' nonclinical and clinical characteristics were analyzed. We used a full matching technique to compare characteristics between those admitted to rehabilitation (cases) to those discharged home (controls). We matched patients by age category, sex, maximum Abbreviated Injury Scale, and body region of maximum Abbreviated Injury Scale. We used survey-based multivariate logistic regression to identify characteristics associated with inpatient rehabilitation services, controlling for multiple injuries, distance from home to rehabilitation center, year of service, hospital length of stay, and clinically relevant interactions. Results Ninety-eight patients (8.6%) were admitted to inpatient rehabilitation and 968 (85.0%) were discharged home. Black and other minority patients had increased odds of receiving inpatient rehabilitation compared with white patients (OR, 7.6 [ P   <  .001] and OR, 1.6 [ P   =  .03], respectively). Patients with private compared with public insurance had increased odds of receiving inpatient rehabilitation (OR, 2.4; P   <  .001). Conclusions Pediatric inpatient rehabilitation beds are a scarce resource that should be available to those with the greatest clinical need. The mechanism creating differences in the use of inpatient rehabilitation based on nonclinical characteristics such as race/ethnicity or insurance status must be understood to prevent disparities in access to inpatient rehabilitation services.