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 ≤19y) 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.
Keywords
List of abbreviations:
CDC (Centers for Disease Control and Prevention), ICD-9 (International Classification of Diseases, Ninth Revision), SID (State Inpatient Database), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 13, 2014
Footnotes
Current affiliation for Greene, Duke University School of Medicine, Durham, NC.
Supported by the University of Washington Department of Anesthesiology and Pain Medicine.
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
