Gaps in access to comprehensive rehabilitation following traumatic injuries in children: A nationwide examination

Introduction: Acute rehabilitation following traumatic injuries is associated with improved functional recovery. Access is often limited to patients at the time of hospital discharge. This phenomenon remains less well described in children, who may have more to benefit with rehabilitation posttrauma. This study aims to determine factors influencing access to rehabilitation among children with traumatic injuries utilizing a nationally representative sample. Methods: The Kids Inpatient Database (2000-2012) was queried for trauma patients. The outcome measure of interest was discharge with rehabilitative services [acute rehabilitation facilities or home healthcare (HHC)]. Patients that did not survive and those that did not meet hospital admission criteria were excluded. Multivariable models adjusted for age, race/ethnicity, gender, insurance-status, income, injury severity score, year, children's hospital designation, hospital-volume, teaching status, location, and geographical region. Results: A total of 811,941 records were included These were predominantly male (65.9%) with an average age of 11.6 (+/- 6.7) years. 4.2% were discharged to rehabilitation facilities, and 3.9% were discharged with HHC. African-American and Hispanic patients were less likely to be placed/have access to rehabilitation facilities (p < 0.001). Similarly, uninsured patients were less likely to receive these services postdischarge (p < 0.05). However, patients with government insurance, those in the highest income-quartile, those treated at children's hospitals, and those treated at teaching and urban hospitals were more likely to be placed/have access to rehabilitation services. Conclusion: Race/ethnicity and insurance status are associated with disparities in access to postdischarge rehabilitation in pediatric trauma patients. Moreover, treatment at designated children's, teaching and urban hospitals better-facilitates discharge planning with rehabilitative services. (C) 2019 Elsevier Inc. All rights reserved.