Behavioral Outcomes After Inpatient Rehabilitation in Pediatric and Adolescent Trauma Patients

Abstract

Introduction: Traumatic injury is the leading cause of pediatric mortality and morbidity in the United States. While behavioral impairments of children after traumatic brain injury (TBI) have been described, outcomes following traumatic spinal cord injury (SCI) and multi-trauma (MT) are less known. We aimed to address the prevalence of behavioral and neuropsychiatric disorders in pediatric and adolescent trauma patients.

Methods: We performed a single-center retrospective review of patients ≤18 years of age admitted to inpatient rehabilitation after traumatic injury from January 2018-December 2020. Patients were classified as having behavioral issues if they had a new psychiatric or behavioral diagnosis, or if their previously diagnosed condition was categorized as worsened after traumatic injury.

Results: Ninety-seven patients were included. 61 patients had TBI, 18 SCI, and 18 MT. Rates of attention deficit hyperactivity disorder (MT 33.3 %), post-traumatic stress disorder (SCI 21.5 %, MT 22.2 %), neurocognitive disorder (TBI 40 %, MT 50 %), and school issues (TBI 59 %, MT 43.8 %) were increased (p < 0.05). Flat affect (61.7 % TBI, 63.2 % SCI, 77.8 % MT), depression (TBI 18.3 %, SCI 36.8 %, MT 33.3 %), aggression (TBI 27 %, SCI 10.5 %, MT 27.8 %), and anxiety (TBI 21.7 %, SCI 31.6 %, MT 50 %) were seen at high rates across all injury types. School disruption problems arose most commonly at 5.6 months (range 0-19 months) after discharge. 43 % of parents reported lack of access to resources as a barrier to follow up.

Conclusion: Many behavioral and psychiatric sequelae are prevalent regardless of injury mechanism. Patients should be followed long term for these sequalae to ensure they receive appropriate therapies.

Type of study: Retrospective cohort study.

Keywords: Behavioral disorders; Neuropsychiatric disorders; Pediatric trauma; Physical medicine rehabilitation.