title: Variation in pediatric traumatic brain injury outcomes in the United States.
abstract: OBJECTIVE
  To ascertain the degree of variation, by state of hospitalization, in outcomes associated with traumatic brain injury (TBI) in a pediatric population.
  
  
  METHODS
  A retrospective cohort study of pediatric patients admitted to a hospital with a TBI.
  
  
  METHODS
  Hospitals from states in the United States that voluntarily participate in the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project.
  
  
  METHODS
  Pediatric (age ≤ 19 y) patients hospitalized for TBI (N=71,476) in the United States during 2001, 2004, 2007, and 2010.
  
  
  METHODS
  None.
  
  
  METHODS
  Primary outcome was proportion of patients discharged to rehabilitation after an acute care hospitalization among alive discharges. The secondary outcome was inpatient mortality.
  
  
  RESULTS
  The relative risk of discharge to inpatient rehabilitation varied by as much as 3-fold among the states, and the relative risk of inpatient mortality varied by as much as nearly 2-fold. In the United States, approximately 1981 patients could be discharged to inpatient rehabilitation care if the observed variation in outcomes was eliminated.
  
  
  CONCLUSIONS
  There was significant variation between states in both rehabilitation discharge and inpatient mortality after adjusting for variables known to affect each outcome. Future efforts should be focused on identifying the cause of this state-to-state variation, its relationship to patient outcome, and standardizing treatment across the United States.
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA. Electronic address: nathaniel.greene@duke.edu.
authors.forename: Nathaniel H
authors.initials: NH
authors.lastname: Greene
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Kernic
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D054625:Healthcare Disparities; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D010360:Patient Transfer / Q000379:methods; D026741:Physical Therapy Modalities; D016012:Poisson Distribution; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Healthcare disparities; Patient outcome assessment; Rehabilitation; Traumatic brain injury