Outcomes for children with acquired brain injury (ABI) admitted to acute neurorehabilitation

Abstract

Aim To evaluate an innovative paediatric neurorehabilitation model in relation to improving quality of neurorehabilitation and reducing length of stay (LOS) for children with acquired brain injury. Method A process evaluation approach was conducted in line with Medical Research Council evaluation of complex interventions guidance. Analysis was conducted on routinely collected patient data from 2017 to 2018, including LOS and family feedback. Descriptive and inferential statistics were used for quantitative analysis and qualitative data was analysed thematically. Results Outcomes for 70 children (0–16y, median age 5y, IQR 1–11y, 46 males, 24 females) referred to the service indicated improved function and reduced complexity of need. The mean LOS was 10.6 days compared to baseline mean LOS of 41 days (2011–2012). High satisfaction from the families was recorded; however, ongoing needs and service gaps regarding long‐term support were identified. Interpretation This service model is effective in delivering quality paediatric neurorehabilitation, demonstrating a sustained impact on LOS, and positive patient outcome data and family feedback for this group of patients. Investment in early intensive neurorehabilitation and supported discharge impacts length of stay (LOS) for children with acquired brain injury. Early intensive neurorehabilitation and supported discharge is effective. This is demonstrated by a sustained reduction in LOS, positive patient outcomes, and family feedback.

Parents’ experience of children with acquired brain injury undergoing neuro-rehabilitation: thematic synthesis protocol

“… 1 ABI can be caused by trauma such as road traffic collision, fall or physical assault; or non-traumatic causes such as stroke, infection or brain tumour. 2 Worldwide, traumatic brain injury (TBI) is the main cause of death and disability in children and young people (CYP) up to the age of 25. 2 3 For example, every year in the United Kingdom (UK), at least 35 000 CYP with TBI are admitted to hospital; and around 4000 children up to the age of 16 require admission related to non-TBI.…”

“… 2 Worldwide, traumatic brain injury (TBI) is the main cause of death and disability in children and young people (CYP) up to the age of 25. 2 3 For example, every year in the United Kingdom (UK), at least 35 000 CYP with TBI are admitted to hospital; and around 4000 children up to the age of 16 require admission related to non-TBI. 4 The estimated annual incidence of TBI in England is 400 per 100 000 children younger than 15 years.…”

“… 6 These impairments can be temporary or permanent, with varying severity. 2 Severe ABI in young children is associated with worse neurocognitive and psychological outcomes as it impedes the immediate and future development of physical and cognitive skills. 7 Severe ABI is linked with a greater risk of developing profound disabilities that will be carried into adulthood.…”

Redesigning neurorehabilitation services for children with acquired brain injury

“…Lastly, Keetley et al 2 revealed important benefits attached to the implementation of their innovative model of care in a major trauma center; the average length of stay significantly decreased from 41 days to 10.6 days after implementation. Although this study does not provide other important indicators of effectiveness (e.g., improvement of children outcome pre‐ vs post‐implementation), it provides emerging evidence of organizational and economic benefits to integrated rehabilitation service models and thus should appeal to health care policymakers and managers.…”

“…The innovative paediatric neurorehabilitation service model described in the study by Keetley et al 2 is a much‐needed example of how redesigned rehabilitation delivery in acute care enables both early detection of rehabilitation needs (86% of children referred to the dedicated multidisciplinary team required some type of rehabilitation) and timely referral to post‐acute rehabilitation. Adult ABI clinical practice guidelines have long advocated for dedicated multidisciplinary teams in acute care units and they are implemented in many facilities.…”