title: Initiation of physical, occupational, and speech therapy in children with traumatic brain injury.
abstract: OBJECTIVE
  (1) To determine factors associated with physical therapy (PT) or occupational therapy (OT) evaluation and speech or swallow therapy evaluation in hospitalized children with traumatic brain injury (TBI); (2) to describe when during the hospital stay the initial therapy evaluations typically occur; and (3) to quantify any between-hospital variation in therapy evaluation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Children's hospitals participating in the Pediatric Health Information System database (January 2001-June 2011).
  
  
  METHODS
  Children (age <18y) with TBI (N=21,399) who were admitted to the intensive care unit and survived to hospital discharge.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  PT or OT evaluation and speech or swallow therapy evaluation. A propensity score was calculated to allow comparison of expected with observed rates of therapy evaluations by the hospital.
  
  
  RESULTS
  The median hospital length of stay was 5 days (interquartile range, 3-10d). Overall, 8748 (41%) of 21,399 children received either a PT or OT evaluation, and 5490 (26%) out of 21,399 children received either a speech or swallow evaluation. Older children and those with higher energy injury mechanisms, more severe injuries, extremity fractures, more treatment with neuromuscular blocking agents or pentobarbital, and admission to a hospital with an American College of Surgeons Level I pediatric trauma designation were more likely to receive therapy evaluations. The median time until the first therapy evaluation was 5 (PT or OT) and 7 days (speech or swallow). Expected hospital evaluation rates were 25% to 54% (PT or OT) and 16% to 35% (speech or swallow), while observed hospital evaluation rates were 11% to 74% (PT or OT) and 4% to 55% (speech or swallow).
  
  
  CONCLUSIONS
  There is wide between-hospital variation in provision of rehabilitation therapies for children with TBI. Evidence-based criteria for initiation of routine therapy evaluations after TBI are needed.
authors.affiliation: Pediatric Critical Care, University of Utah School of Medicine, Salt Lake City, UT 84158, USA. tell.bennett@hsc.utah.edu
authors.forename: Tellen D
authors.initials: TD
authors.lastname: Bennett
authors.forename: Christian M
authors.initials: CM
authors.lastname: Niedzwecki
authors.forename: E Kent
authors.initials: EK
authors.lastname: Korgenski
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D003679:Deglutition; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D009788:Occupational Therapy / Q000706:statistics & numerical data*; D026761:Physical Therapy Specialty / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013070:Speech Therapy / Q000706:statistics & numerical data*; D013997:Time Factors; D015599:Trauma Severity Indices