Objective:

Does insurance status impact if children hospitalized with acute TBI are discharged to inpatient rehabilitation post hospitalization?

Background:

Insurance status is recognized as a potential determinant of outcomes among hospitalized children. Traumatic brain injury (TBI), a major cause of morbidity and mortality in children. There is limited data on how insurance status impacts discharge disposition, particularly discharge to inpatient rehabilitation. This study aimed to evaluate if uninsured children hospitalized with acute TBI are less likely to be discharged to inpatient rehabilitation compared to those with public or private insurance.

Design/Methods:

We conducted a retrospective cohort study using National Trauma Data Bank (NTDB) data from 2017 to 2019. Children 0–18 years admitted with TBI and a known insurance status were included. Patients were categorized into groups based on having no insurance, public insurance, or private insurance. Propensity score matching (PSM) was used to match patients without insurance 1:1:1 to patients with public and private insurance to adjust for differences in baseline demographics, injury severity, and clinical management. The primary outcome was discharge to inpatient rehabilitation. Secondary outcomes included hospital mortality, intensive care unit (ICU) and hospital length of stay (LOS), and highest documented Glasgow Coma Scale (GCS) score.

Results:

There were 83,774 patients who met inclusion criteria with 5,352 (6%) being uninsured, 39,398 (47%) having public insurance, and 39,024 (47%) having private insurance. After PSM, 5,096 matched triplets were analyzed. In the unmatched cohort, uninsured children were significantly less likely to be discharged to inpatient rehab (3.7%) compared to those with public (5.7%) or private insurance (6.5%) (p<0.00001). Additionally, uninsured patients had higher in-hospital mortality, shorter ICU LOS, and shorter hospital LOS but a similar highest documented GCS. 

Conclusions: