Health Care Utilization and Needs After Pediatric Traumatic Brain Injury

Abstract

A substantial proportion of children with TBI had unmet or unrecognized health care needs during the first year after injury. It is recommended that pediatricians be involved in the post-acute care follow-up of children with TBI to ensure that the injured child's needs are being addressed in a timely and appropriate manner. One of the recommendations that trauma center providers should make on hospital discharge is that the parent/primary caregiver schedule a visit with the child's pediatrician regardless of the post-acute services that the child may be receiving. Because unmet and unrecognized need was highest for cognitive services, it is important to screen for cognitive dysfunction in the primary care setting. Finally, because the health care needs of children with TBI change over time, it is important for pediatricians to monitor their recovery to ensure that children with TBI receive the services that they need to restore their health after injury.

Long-term cognitive outcome of childhood traumatic brain injury

“…However, help from health care professionals are often missing after CTBI (Hawley 2006, Slomine et al, 2006. 12 months after injury, 31% of parents of children with CTBI reported unmet or unrecognized health care needs, with the most frequent type of unmet need being for cognitive services.…”

“…12 months after injury, 31% of parents of children with CTBI reported unmet or unrecognized health care needs, with the most frequent type of unmet need being for cognitive services. The top three reasons given for needs to remain unmet were: that interventions were not recommended by doctor, not recommended or provided by school, and finally, costing too much (Slomine et al, 2006). The caregivers with psychosocial problems prior to a CTBI were three times more likely to report unmet needs compared to caregivers to children without preexisting psychosocial problems (Slomine et al, 2006).…”

“…According to the extensive evaluation of parental ratings conducted by Hawley (2003) and the evaluation of unmet needs by Slomine et al (2006), follow-ups should be made available to the entire group of patients with a CTBI, that is mild to moderate, when the families notice TBI-related alterations in everyday functions, or in the event that the health professionals know that soon everyday life, or up-coming developmental paths, might be influenced by the TBI. The final evaluation of outcome after a moderate to severe CTBI should not be conducted before adulthood.…”

Medical Care Costs Associated with Traumatic Brain Injury over the Full Spectrum of Disease: A Controlled Population-Based Study

“…Of the few cohort studies that followed unique individuals for costs after the initial encounter, most were limited to persons admitted to the hospital and/or who survived to rehabilitation. Many were limited to specific age groups or mechanisms of injury, and some relied on self-report of injury and/or utilization (Brener et al, 2004;Brooks et al, 1995;Cameron et al, 2008;King et al, 2010;Slomine et al, 2006;Vangel et al, 2005;Whitlock and Hamilton, 1995). Existing estimates of TBI-associated medical care costs have thus been characterized as incomplete and subject to ascertainment, participation, recall, and survivor bias (Berg et al, 2005;Borg et al, 2004;Corrigan et al, 2003;Thurman, 2001).…”

Use of health care services 6 months following major trauma

“…[1][2][3][4][5] Few studies have described the use of health care services post-trauma, 1,6,7 and the relationship between health care service use and ongoing disability experienced by patients is unknown. Understanding the degree of disability experienced by trauma survivors and their pattern of support and outpatient services use is important for evaluating management approaches and improving health service provision.…”