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Physical Disability Following Injury-Related Inpatient Rehabilitation In Children

Monday, October 22, 2012: 4:30 PM
Versailles Ballroom (Hilton Riverside)
Mark R. Zonfrillo, MD, MSCE1, Flaura K. Winston, MD, PhD1, Dennis R. Durbin, MD, MSCE1 and Margaret G. Stineman, MD2, (1)Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, (2)Center for Clinical Epidemiology and Biostatistics, Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA


Injury is the leading cause of death and disability in children. Disabling injuries can have significant consequences on functionality and quality of life. No current estimates of long-term disability after injury-related pediatric rehabilitation are available to guide prevention, acute care, and rehabilitation efforts. The aim of this study was to determine the residual functional disability after inpatient rehabilitation for a contemporary cohort of older children with traumatic injuries.


This was a retrospective cohort study of patients 7-18 years old who underwent inpatient rehabilitation for traumatic injuries from 2002-2011. Patients were identified from the Uniform Data System for Medical Rehabilitation, representing more than 829 (~72%) of the United States Centers for Medicare & Medicaid (CMS)-based Inpatient Rehabilitation Facilities (IRF). Injuries were categorized by standardized rehabilitation-center designated impairment codes. Functional outcome at the time of discharge was based on the Functional Independence Measure (FIM) instrument, which has previously been used to evaluate trauma-related disability at short and long term intervals in children. The absolute FIM scores have been previously categorized into clinically relevant grades consisting of standardized levels of physical achievement from grade 1 (need for total assistance) to grade 7 (completely independent for all self-care and mobility).


13,798 injured children underwent inpatient rehabilitation. The Table demonstrates the distribution of functional grades and length of stay. After an overall mean 3-week length of stay, functional limitations were reduced but children still tended to have residual physical disability (median grade on admission, 1; median grade on discharge, 4), with greater disability remaining in patients with spinal cord injuries SCIs (median grade 2). 43.3% of patients had a discharge functional grade of 1-3 (moderate to severe disability). In addition to higher physical disability upon discharge, children with SCIs, either alone or in combination with other injuries, had longer lengths of stay and more co-morbidities than those with traumatic brain injuries (TBIs), burns, and multiple injuries (P-value <0.0001 for all comparisons).


Children had very severe physical disabilities upon admission to inpatient rehabilitation for traumatic injuries. TBI patients with significant physical disability upon admission were able to improve their functionality by discharge. SCI patients have longer lengths of stay, more comorbidities, and more physical disability upon discharge. Results suggest that perhaps only the most severely affected children are being referred to inpatient rehabilitation. Future studies should explore whether those less severely injured may benefit from inpatient therapy.