title: Residual cognitive disability after completion of inpatient rehabilitation among injured children.
abstract: OBJECTIVE
  To determine the prevalence and nature of residual cognitive disability after inpatient rehabilitation for children aged 7-18 years with traumatic injuries.
  
  
  METHODS
  This retrospective cohort study included children aged 7-18 years in the Uniform Data System for Medical Rehabilitation who underwent inpatient rehabilitation for traumatic injuries in 523 facilities from 2002-2011. Traumatic injuries were identified by standardized Medicare Inpatient Rehabilitation Facility-Patient Assessment Instrument codes. Cognitive outcomes were measured by the Functional Independence Measure instrument. A validated, categorical staging system derived from responses to the items in the cognitive domain of the functional independence measure was used and consisted of clinically relevant levels of cognitive achievement from stage 1 (total cognitive disability) to stage 7 (completely independent cognitive function).
  
  
  RESULTS
  There were 13,798 injured children who completed inpatient rehabilitation during the 10-year period. On admission to inpatient rehabilitation, patients with traumatic brain injury (TBI) had more cognitive disability (median stage 2) than those with spinal cord injury or other injuries (median stage 5). Cognitive functioning improved for all patients, but children with TBI still tended to have significant residual cognitive disability (median stage on discharge, 4).
  
  
  CONCLUSIONS
  Injured children gained cognitive functionality throughout inpatient rehabilitation. Those with TBI had more severe cognitive disability on admission and more residual disability on discharge. This is important not only for patient and family expectation setting but also for resource and service planning, as discharge from inpatient rehabilitation is a critical milestone for reintegration into society for children with serious injury.
authors.affiliation: Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: Zonfrillo@email.chop.edu.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Zonfrillo
authors.affiliation: Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Durbin
authors.affiliation: Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Flaura K
authors.initials: FK
authors.lastname: Winston
authors.affiliation: Biostatistics and Data Management Core, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: FIM; Functional Independence Measure; IRF-PAI; Inpatient Rehabilitation Facilities–Patient Assessment Instrument; LOS; Length of stay; SCI; Spinal cord injury; TBI; Traumatic brain injury; UDSMR; Uniform Data System for Medical Rehabilitation