Follow-Up Care Adherence After Hospital Discharge in Children With Traumatic Brain Injury

• Published in: The journal of head trauma rehabilitation Vol. 33; no. 3; p. E1
• Main Authors: Spaw, Alexandra J, Lundine, Jennifer P, Johnson, Sarah A, Peng, Jin, Wheeler, Krista K, Shi, Junxin, Yang, Ginger, Haley, Kathy J, Groner, Jonathan I, Xiang, Henry
• Format: Journal Article
• Language: English
• Published: United States 01.05.2018
• Subjects: Adolescent; Aftercare - standards; Aftercare - statistics & numerical data; Age Factors; Brain Injuries, Traumatic - diagnosis; Brain Injuries, Traumatic - epidemiology; Brain Injuries, Traumatic - therapy; Child; Child, Preschool; Female; Follow-Up Studies; Hospitals, Pediatric; Humans; Incidence; Infant; Injury Severity Score; Male; Multivariate Analysis; Patient Compliance - statistics & numerical data; Patient Discharge - statistics & numerical data; Registries; Regression Analysis; Retrospective Studies; Risk Assessment; Sex Factors; Trauma Centers; United States; Urban Population; United States
• ISSN: 1550-509X
• DOI: 10.1097/HTR.0000000000000314

To investigate factors associated with follow-up care adherence in children hospitalized because of traumatic brain injury (TBI). An urban level 1 children's hospital trauma registry was queried to identify patients (2-18 years) hospitalized with a TBI in 2013 to 2014. Chart reviewers assessed discharge summaries and follow-up instructions in 4 departments. Three levels of adherence-nonadherence, partial adherence, and full adherence-and their associations with care delivery, patient, and injury factors. In our population, 80% were instructed to follow up within the hospital network. These children were older and had more severe TBIs than those without follow-up instructions and those referred to outside providers. Of the 352 eligible patients, 19.9% were nonadherent, 27.3% were partially adherent, and 52.8% were fully adherent. Those recommended to follow up with more than 1 department had higher odds of partial adherence over nonadherence (adjusted odds ratio [AOR] = 5.8, 95% CI: 1.9-17.9); however, these patients were less likely to be fully adherent (AOR = 0.1; 95% CI: 0.1-0.3). Privately insured patients had a higher AOR of full adherence. Nearly 20% of children hospitalized for TBI never returned for outpatient follow-up and 27% missed appointments. Care providers need to educate families, coordinate service provision, and promote long-term monitoring.