Disparities in provision of rehabilitative services in adolescents with traumatic brain injury at level I adult versus pediatric trauma centers

BACKGROUND – Rehabilitative care after traumatic brain injury (TBI) in children is a high-priority research area. Children often receive different care (e.g., imaging, operative management) when treated in adult trauma centers (ATCs) versus pediatric trauma centers (PTCs). Adolescent patients may be cared for in PTCs or ATCs depending upon local trauma triage criteria. Possibly appearing physically mature, adolescents are still developing. Neurologically focused rehabilitation, vital for optimal recovery, requires a different rehabilitative focus in adolescents as compared with adults. The purpose of this retrospective pilot study was to determine whether adolescents receive similar rehabilitation in ATCs and PTC. We hypothesized that those treated in the PTC would have more robust neurorehabilitation. METHODS – In a county-wide trauma system, patients younger than 15 years are triaged to the PTC and those older than 15 years to ATCs. Retrospective chart review was performed for all adolescents (aged 13–19 years) with moderate/severe injuries admitted to the PTC and two ATCs from 2013 to 2020. Demographics, injury characteristics, and discharge destination were obtained from trauma registries, and rehabilitative care for patients with TBI was obtained from chart review by physical medicine and rehabilitation physicians. Statistical analysis used Student's t test. RESULTS – A total of 345 ATC and 165 PTC patients were included; 87% had TBI. Aside from age, demographics were similar. Injury severity was not different, but there were more victims of violence seen in ATCs. Length of stay and mortality were similar. Patients in the PTC experienced greater involvement of physical medicine and rehabilitation physicians and more neurologically focused therapies, postacute rehabilitation support, and discharge to acute rehabilitation facilities. CONCLUSION – Rehabilitative care of adolescent TBI patients is more robust in the PTC versus ATCs. Whether this is due to available resources or philosophy is unclear. This discrepancy could decrease optimization of care for adolescent trauma patients cared for in ATCs. LEVEL OF EVIDENCE – Therapeutic/Care Management; Level IV.