Use and need for post-acute services following paediatric head injury

Abstract

This paper aims to document the types of inpatient and outpatient post-acute services children receive after discharge from an acute care hospital for head injury and to better understand the extent to which children fail to receive services and the reasons for not receiving needed services. A follow-up was conducted on 95 children (aged 5-15) 1 year after they were hospitalized for head injury. Parents were interviewed by phone concerning their child's use of and need for medical, rehabilitation, and social services since the injury. Questions were also asked regarding the child's current health status and behaviour. Inpatient records were reviewed to obtain information on the characteristics of the injury. Overall use of outpatient rehabilitation and social services was low during the year following injury, ranging from 0-18% of the study sample. Although need for and use of services was positively correlated with head injury severity, it appears that unmet need was highest for children with the least severe head injuries. Finally, need for physical or occupational therapy and mental health services was unrecognized for one third of children with physical limitations and 40% of children with at least 14 identified behaviour problems. These findings underscore the need for physicians and other health care professionals to thoroughly evaluate children during follow-up visits as well as during the initial hospitalization for head injury-related deficits. Identification of functional deficits or behavioural problems should be followed-up by evaluation and treatment by qualified rehabilitation professionals.

Do Children Who Sustain Traumatic Brain Injury in Early Childhood Need and Receive Academic Services 7 Years After Injury?

“…Interestingly, the moderate TBI group had significantly greater frequency of unmet need compared to the OI group, while the severe TBI group did not differ significantly from the moderate TBI group or OI group. This is consistent with studies that have reported high rates of post-injury needs going unmet among those with less severe TBI 51–53 . In particular, this finding is consistent with Glang et al 21 report that less than 7% of children who sustain mild to moderate TBIs receive academic services one year post-injury, placing this group at risk of having unmet needs over time.…”

Utilization of Behavioral Therapy Services Long-Term After Traumatic Brain Injury in Young Children

“…4-12 The findings are also consistent with evidence that even children with less severe TBI often experience persistent difficulties with behavior and social competence 17, 18 and that unmet post-injury clinical needs are common in these children. 19, 20, 40 This study adds to the literature by documenting the high rates of unmet clinical need in these children.…”

“…19 In another study examining utilization of health care services by children 1 year post TBI, occupational therapy and mental health services were the most commonly reported unmet need. 20 …”

“…29 However, we are not aware of research examining utilization of mental health services and the influence of family functioning beyond the first year after TBI. 19, 20 …”

Pediatricians' Knowledge, Attitudes, and Behaviors to Screening Children After Complicated Mild TBI: A Survey

“…Their study found that in comparison to children with moderate or severe TBI, children hospitalized with mild injury defined as a head Abbreviated Injury Score (AIS) of 2, had greater unmet and unrecognized cognitive, behavioral and physical health care needs. 11,12 The AIS classifies severity of injury according to its associated threat to life on an ordinal scale of 1 (minor) to 6 (unsurvivable) for six body regions. 13 Generally, head injury refers to any injury to the head region, which may or may not include a brain injury.…”