Functional outcomes during inpatient rehabilitation for American Indian and Alaska Native children with traumatic brain injury

Abstract

PURPOSE American Indian/Alaska Native (AI/AN) people have the highest traumatic brain injury (TBI)-related mortality in the United States, but little is known about AI/AN children who survive traumatic brain injury (TBI). This study compares function and factors associated with discharge function between AI/AN and White children with TBI during inpatient rehabilitation. METHODS Retrospective national cohort study of 114 AI/AN and 7,267 White children aged 6 months-18 years who received inpatient TBI rehabilitation between 2002–2012 at facilities utilizing the Uniform Data System for Medical Rehabilitation®. The outcome measure was developmental functional quotients (DFQ is the FIM® or WeeFIM® score divided by age norms × 100) at discharge. RESULTS AI/AN race was not associated with motor (regression coefficient (β) 0.18, 95% confidence interval (CI) −2.39, 2.76) or cognitive (β −1.54, 95% CI −3.75, 0.67) function. Among a subgroup with loss of consciousness > 24 hours (AI/AN n = 13, White n = 643), AI/AN race was associated with lower motor DFQ (β −12.83, 95% CI −25.39, −0.34). CONCLUSIONS Overall, AI/AN race was not associated with inpatient rehabilitation function for children with TBI, but providers should not assume AI/ANs with more severe injuries have equitable outcomes.

Traumatic brain injury amongst indigenous people: a systematic review

“…Are the study design and sampling method appropriate for the research question? Faleafa 31 Fuentes, et al 7 Linton, et al 23 1.Was the purpose clearly stated? 1…”

“…In total, 14 studies included populations from the USA 3,4,7,[16][17][18][19][20][21][22][23][24][25][26] , nine studies included populations from New Zealand 2,[27][28][29][30][31][32][33][34] , one study included populations from Australia 35 and, two studies included populations from Canada 8,36 . Studies included in this review focused on the following topics: prevalence or incidence of TBI (n=15), level of injury or recovery (n=2), neuropsychological assessment and TBI (n=3), Indigenous perspectives of TBI (n=2), intervention for TBI (n=1), and rehabilitation for TBI (n=4).…”

“…Of the 26 sources included in this review, presented information about how TBI was diagnosed. Of these , three 2,8,18 identified TBI according to specified scores on the Glasgow Coma Scale (GCS) 38 , one 26 according to the Centre for Disease Control's (CDC) guidelines of surveillance of central nervous system injury 39 , nine 3,4,7,21,22,24,25,27,36 according to the International Classification of Diseases (ICD) 40,41 , one 23 via Injury Severity Scores (ISS), three [33][34][35] according to experiencing a loss of consciousness or blacking out, one 2 by the World Health Organisation (WHO) Injury Surveillance…”

“…Four studies included in this review investigated the outcomes of rehabilitation for Indigenous people with TBI 18,20,31,46 In terms of prevalence and incidence studies, thirteen studies compared findings by race and twelve of these found that Indigenous people had a higher incidence of TBI compared to non-Indigenous people. While the studies included in this review indicate that Indigenous people experience higher rates of TBI than non-Indigenous people, the majority of the research in this area centred on Indigenous people living in the USA and New Zealand.…”

“…Studies which explore the impact of rehabilitation on the functional outcomes of Indigenous people with TBI are also limited 7,8 . Previous systematic reviews focusing on dementia and cognitive impairment among Indigenous people 9,10 and stroke among American Indians and Alaskan Natives (AI/AN) 11 have provided new knowledge concerning the extent of these conditions, and how interventions may be delivered among the populations concerned.…”