|
Affiliation
|
Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA. |
|
Abstract
|
OBJECTIVE: To ascertain the degree of variation, by state of hospitalization, in outcomes associated with traumatic brain injury in a pediatric population.
DESIGN: A retrospective cohort study of pediatric patients admitted to a hospital with a traumatic brain injury. SETTING: Hospitals from states in the United States of America that voluntarily participate in the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. PARTICIPANTS: Pediatric (≤19 years old) patients hospitalized for traumatic brain injury (n=71,476) in the United States during 2001, 2004, 2007, and 2010. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Primary outcome was proportion of patients discharged to rehabilitation after an acute care hospitalization among alive discharges. The secondary outcome was inpatient mortality.
RESULTS: The relative risk of discharge to inpatient rehabilitation varied by as much as three-fold among the states and the relative risk of inpatient mortality varied by as much as nearly two-fold. In the United States, approximately 1,981 patients could be discharged to inpatient rehabilitation care if the observed variation in outcomes was eliminated.
CONCLUSIONS: There was significant variation between states in both rehabilitation discharge and inpatient mortality after adjusting for variables known to affect each outcome. Future efforts should be focused on identifying the cause of this state-to-state variation, its relationship to patient outcome, and standardizing treatment across the United States.
Language: en |