Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah (Dr Nelson and Mr Ma); Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (Dr Nelson); Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City (Mr Ma); George Washington University Informatics Center, Washington, District of Columbia (Dr Cheng); Department of Pediatrics, University of Texas Houston Health Sciences Center (Dr Ewing-Cobbs); and Department of Pediatrics, University of Utah, Salt Lake City (Ms Clark and Dr Keenan).
J Head Trauma Rehabil. 2019 Jul/Aug;34(4):257-267. doi: 10.1097/HTR.0000000000000458.
We enrolled patients in a prospective study in which we obtained estimates of the direct and indirect burden for families of children with traumatic brain injury (TBI) relative to a control group of families of children with orthopedic injury (OI).
Parents were surveyed at 3 time points following injury: 3, 6, and 12 months. At each follow-up contact, we asked parents to list the number of workdays missed, number of miles traveled, amount of travel-related costs, and whether their child had an emergency department (ED) visit, hospital admission, any over-the-counter (OTC) medications, and any prescription medications during that time period. We assessed the difference in these outcomes between the TBI and OI groups using multivariable logistic and 2-part regression models to account for high concentrations of zero values.
Children with TBI had significantly greater odds of having an ED visit (3.04; 95% CI, 1.12-8.24), OTC medications (1.98; 95% CI, 1.34-2.94), and prescription medications (2.34; 95% CI, 1.19-4.59) than those with OI. In addition, parents of children with TBI missed significantly more days of work (19.91 days; 95% CI, 11.64-28.17) overall during the 12 months following injury than their OI counterparts.
Extrapolating our results to the entire country, we estimate that pediatric TBI is associated with more than 670 000 lost workdays annually over the 12 months following injury, which translates into more than $150 million in lost productivity. These missed workdays and lost productivity may be prevented through safety efforts to reduce pediatric TBI.
我们招募了一组前瞻性研究中的患者，以评估相对于骨科损伤（OI）对照组，创伤性脑损伤（TBI）患儿家庭的直接和间接负担。
在损伤后 3、6 和 12 个月，父母接受了 3 次调查。在每次随访中，我们询问父母在这段时间内错过了多少个工作日、行驶了多少英里、交通相关费用是多少，以及他们的孩子是否去过急诊室（ED）、住院、使用过非处方（OTC）药物或处方药物。我们使用多变量逻辑和两部分回归模型来评估 TBI 和 OI 组之间这些结果的差异，以解释高浓度的零值。
TBI 患儿去 ED 的可能性明显更高（3.04；95%CI，1.12-8.24）、使用 OTC 药物的可能性更高（1.98；95%CI，1.34-2.94）、使用处方药物的可能性更高（2.34；95%CI，1.19-4.59）。此外，在受伤后 12 个月内，TBI 患儿的父母整体上错过的工作日数明显更多（19.91 天；95%CI，11.64-28.17）。
将我们的结果推断至整个国家，我们估计每年在受伤后 12 个月内，儿科 TBI 导致超过 670 000 个工作日缺勤，这意味着超过 1.5 亿美元的生产力损失。通过减少儿科 TBI 的安全措施，可以预防这些工作日缺勤和生产力损失。
