Functional independence after inpatient rehabilitation for traumatic brain injury among minority children and adolescents.
OBJECTIVE
To compare motor and cognitive functional independence scores between Hispanic, non-Hispanic black (NHB), and non-Hispanic white (NHW) children with traumatic brain injury (TBI) after discharge from inpatient rehabilitation.


METHODS
Retrospective cohort study using the Uniform Data System for Medical Rehabilitation national dataset from the years 2002 to 2012.


METHODS
Inpatient rehabilitation units.


METHODS
Children (N=10,141) aged 6 months to 18 years who received inpatient rehabilitation for TBI.


METHODS
Not applicable.


METHODS
Motor and cognitive functional independence after discharge from inpatient rehabilitation, adjusting for age, sex, admission function, length of stay, insurance, and region.


RESULTS
Inpatient rehabilitation therapy improved functional independence for all children. Younger age, lower admission functional independence scores, and Medicaid insurance were associated with lower functional independence at discharge. Hispanic and NHB children had lower discharge cognitive scores compared with NHW children; however, differences were small and were partially explained by insurance status and region. Children who received rehabilitation therapy at pediatric facilities had greater cognitive improvement.


CONCLUSIONS
While racial/ethnic disparities are small, minority children are more likely to be younger, to have Medicaid, and to be cared for at nonpediatric facilities, factors that increase their risk for lower functional outcomes.
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA. Electronic address: nathalia.jimenez@seattlechildrens.org.
Nathalia
N
Jimenez
Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
Marisa
M
Osorio
The Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, WA.
Jessica L
JL
Ramos
Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
Susan
S
Apkon
Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA; The Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA.
Beth E
BE
Ebel
Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA.
Frederick P
FP
Rivara
D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D001930:Brain Injuries / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007297:Inpatients; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008913:Minority Groups / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data*; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D044465:White People / Q000706:statistics & numerical data
Brain injuries; Minority groups; Outcome; Rehabilitation