Changing Healthcare and School Needs in the First Year After Traumatic Brain Injury.

OBJECTIVE

To examine children's unmet and unrecognized healthcare and school needs following traumatic brain injury (TBI).

SETTING

Two pediatric trauma centers.

PARTICIPANTS

Children with all severity of TBI aged 4 to 15 years.

DESIGN

Prospective cohort.

MAIN MEASURES

Caregivers provided child health and school service use 3 and 12 months postinjury. Unmet and unrecognized needs were categorized compared with norms on standardized physical, cognitive, socioemotional health, or academic competence measures in conjunction with caregiver report of needs and services. Modified Poisson models examined child and family predictors of unmet and unrecognized needs.

RESULTS

Of 322 children, 28% had unmet or unrecognized healthcare or school needs at 3 months, decreasing to 24% at 12 months. Unmet healthcare needs changed from primarily physical (79%) at 3 months to cognitive (47%) and/or socioemotional needs (68%) at 12 months. At 3 months, low social capital, preexisting psychological diagnoses, and 6 to 11 years of age predicted higher healthcare needs and severe TBI predicted higher school needs. Twelve months postinjury, prior inpatient rehabilitation, low income, and preexisting psychological diagnoses were associated with higher healthcare needs; family function was important for school and healthcare needs.

CONCLUSIONS

Targeted interventions to provide family supports may increase children's access to services.