Functional independence after inpatient rehabilitation for traumatic brain injury among minority children and adolescents.

OBJECTIVE

To compare motor and cognitive functional independence scores between Hispanic, non-Hispanic black (NHB), and non-Hispanic white (NHW) children with traumatic brain injury (TBI) after discharge from inpatient rehabilitation.

DESIGN

Retrospective cohort study using the Uniform Data System for Medical Rehabilitation national dataset from the years 2002 to 2012.

SETTING

Inpatient rehabilitation units.

PARTICIPANTS

Children (N=10,141) aged 6 months to 18 years who received inpatient rehabilitation for TBI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Motor and cognitive functional independence after discharge from inpatient rehabilitation, adjusting for age, sex, admission function, length of stay, insurance, and region.

RESULTS

Inpatient rehabilitation therapy improved functional independence for all children. Younger age, lower admission functional independence scores, and Medicaid insurance were associated with lower functional independence at discharge. Hispanic and NHB children had lower discharge cognitive scores compared with NHW children; however, differences were small and were partially explained by insurance status and region. Children who received rehabilitation therapy at pediatric facilities had greater cognitive improvement.

CONCLUSIONS

While racial/ethnic disparities are small, minority children are more likely to be younger, to have Medicaid, and to be cared for at nonpediatric facilities, factors that increase their risk for lower functional outcomes.