Children With Severe Head Injuries Need Care After Rehab, CHOP Study Finds

October 24, 2013 — A new study from The Children’s Hospital of Philadelphia (CHOP) published today in the Journal of Pediatrics found that while most children improved cognitive function while in inpatient rehabilitation, those with traumatic brain injury (TBI) were discharged with significant cognitive functioning deficits affecting memory, problem solving, and verbal communication that would require continued support. Researchers recommend that parents and their child’s primary care physician to coordinate reentry to home and school.

The study analyzed the cognitive deficits of nearly 14,000 children (ages 7 to 18 years) from 2002-2011, before and after admission to inpatient rehabilitation for trauma-related injuries, using the Functional Independence Measure (FIM). Children with TBI had more cognitive disability when entering inpatient rehab than other seriously injured children, including those with spinal cord injury, multiple fractures/amputation, and burns. While all injury groups showed improvements upon discharge, the TBI group had severe cognitive disability upon admission and improved to only moderate disability upon discharge.  

After rehabilitation, children with severe head injuries may need help with problem solving and memory

“At discharge, children with moderate cognitive disability can usually communicate and express needs but may need prompting for problem solving and memory,” says Mark Zonfrillo, MD, MSCE, senior researcher at the Center for Injury Research and Prevention at CHOP and associate director of research in the Division of Emergency Medicine at CHOP. “These children may continue to improve after discharge, so this transition is a critical point in their care.”

A previous study from CHOP, published last year in Pediatrics, assessed physical disabilities for this same group of children. That study also demonstrated improvements throughout rehabilitation, but children with spinal cord injuries had longer lengths of stays and more physical disability at discharge. Even though many of these children improved functionally, they still required assistance for day-to-day tasks.

Primary care providers, rehab staff and parents need to communication during transition

According to Dr. Zonfrillo, while primary care providers do not care for these children in the hospital ICU or during inpatient rehabilitation, they are responsible for a patient’s ongoing holistic care. Thus, primary care providers, hospital rehabilitation staff, and parents need to communicate with each other during this transition period. Additionally, many states have programs and services that can help these efforts, including brain injury associations and organizations.

“There is a concern that socioeconomically disadvantaged families may have additional challenges with their child reentering society,” says Dr. Zonfrillo. “Some families may not have the social support or economic means to know how to help their child after returning home, and they need to know that their child’s primary care provider can coordinate access to the resources they need.”

Dr. Zonfrillo plans to next look at the demographics of serious pediatric injury recovery, including which specific injuries cause the most long-term care needs and which groups have better health outcomes for these specific injuries. Factors to be analyzed include sex, socioeconomic status, insurance, race, access to care, and injury severity. 

Goal is maximizing access to trauma systems and optimizing acute and rehabilitation care

“The goal of this line of research at CHOP is to maximize access to trauma systems and to optimize acute and rehabilitation care for young patients with serious injuries,” says Dr. Zonfrillo. “If we have a complete picture of the scale of pediatric traumatic injuries and related long-term needs, as well as the differences between injury patterns and various outcomes, we can predict the type and level of support necessary upon discharge from inpatient rehabilitation.”

Study authors: Mark R. Zonfrillo, MD, MSCE, Dennis R. Durbin, MD, MSCE, Flaura K. Winston, MD, PhD, Xuemei Zhang, MS, Margaret G. Stineman, MD

About The Center for Injury Research and Prevention at The Children's Hospital of Philadelphia

The Center for Injury Research and Prevention at The Children's Hospital of Philadelphia was established in 1998 to advance the safety and health of children, adolescents, and young adults through comprehensive research that encompasses before-the-injury prevention to after-the-injury healing.

The Center's multidisciplinary research team, with expertise in the Behavioral Sciences; Medicine; Engineering; Epidemiology and Biostatistics; Human Factors; Public Health; and Communications, translates rigorous scientific research into practical tools and guidelines for families, professionals, and policymakers to ensure research results extend to the real world.