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Identifying Health Disparities and Health Care Inequities Between Children With Special Health Care Needs With and Without Disabilities
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Conclusions: In this study group, a healthy weight (BMI percentile) and participation both contributed to an enhanced QoL. In contrast, extent of the participants’ motor abilities had no impact on their QoL. Further research is underway to examine selected components of physical fitness, to explore their relationship with BMI and to inform interventional strategies and physical fitness goals for children and adolescents with CP. Identifying Health Disparities and Health Care Inequities Between Children With Special Health Care Needs With and Without Disabilities. Amy J. Houtrow, MD, MPH (University of California San Francisco, San Francisco, CA); Megumi J. Okumura, MD; Roberta S. Rehm, PhD, RN. Disclosures: A. J. Houtrow, None. Objective: Children with disabilities are among the most vulnerable members of society. Understanding the experiences of these children can help inform policies to improve health outcomes. The objective of this study was to compare children with special health care needs (CSHCN) with and without disabilities in terms of their health disparities and health care inequities. Design: Secondary data analysis was performed by using the National Survey of CSHCN, 2005-06. CSHCN with disabilities were identified by using the CSHCN Screener, which asked if the child had an ongoing limitation in his or her ability to do the things that other children of the same age can do due to a condition that has lasted or is expected to last at least 1 year. We stratified CSHCN by disability status for comparison purposes. Statistics were calculated by using STATA. Setting: National Survey of Children with Special Health Care Needs, 2005-06. Participants: A nationally representative sample of children with special health care needs, N⫽40,723. Interventions: None. Main Outcome Measures: Presence of disabilities by demographic characteristics. Differences in health status, health service use, unmet need, and care within a medical home by disability status. Results: 2.2 million CSHCN have disabilities. Blacks, Hispanics, publicly insured children, children living in poverty, and children raised by single parents are disproportionally affected by disability. The health conditions of CSHCN with disabilities compared with other CSHCN were more commonly deemed severe (26% vs 4%) and unstable (16%vs 4%). CSHCN with disabilities had higher rates of utilization and unmet need compared with other CSHCN. Less than a third of CSHCN with disabilities received care in a medical home compared with more than 50% of other CSHCN. Conclusions: This survey identified some important disparities and health care inequities among CSHCN. CSHCN
PRESENTATIONS
with disabilities have more adverse health consequences and have more difficulty accessing services, including care within a medical home. Health policies should assure that the needs of this population are met because these children are most at risk for negative consequences. Predicting Total Duration of Impaired Consciousness in Children With Traumatic Brain Injury. Stacy J. Suskauer, MD (Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, MD); Ellen DeMatt; Cynthia F. Salorio, PhD; Beth S. Slomine, PhD. Disclosures: S. J. Suskauer, None. Objective: To identify predictors of total duration of impaired consciousness in children with traumatic brain injury (TBI) who were undergoing inpatient rehabilitation. Design: Retrospective analysis of clinical data obtained over 10 years. Setting: Academically affiliated pediatric inpatient brain injury rehabilitation program. Participants: 110 children (3-18 years old) with moderate or severe TBI. Interventions: Not applicable. Main Outcome Measures: Time to follow commands (TFC) was defined as time from brain injury until the child was able to follow commands twice within a 24-hour period. Posttraumatic amnesia (PTA) was defined as the time from TFC until the child obtained 2 consecutive scores within 2 standard deviations of the age-based mean on the Children’s Orientation and Amnesia Test (COAT). Total duration of impaired consciousness was defined as TFC plus PTA. Results: Simple linear regression modeling revealed TFC⫹PTA (days) ⫽ 1.8 (TFC) ⫹ 10. TFC accounted for 75% of the variability in TFC⫹PTA (P⬍.001). In univariate regression models, other predictors of TFC⫹PTA included pre-resuscitation Glasgow Coma Scale score, cranial surgical intervention, and depth of lesion on clinical imaging. In a multiple regression model, only TFC survived as a predictor of TFC⫹PTA. Conclusions: TFC is an important predictor of total duration of impaired consciousness in children with moderate or severe TBI who require inpatient rehabilitation. This is the first known equation to estimate time to emergence from PTA derived from a cohort exclusively composed of children and may have important relevance for clinical care and research. Future work will be important to further define contributors to duration of impaired consciousness in this population and to investigate how the relationship between TFC and TFC⫹PTA differs among TBI populations, which vary with respect to factors including age and severity of injury.
Conclusions: In this study group, a healthy weight (BMI percentile) and participation both contributed to an enhanced QoL. In contrast, extent of the participants’ motor abilities had no impact on their QoL. Further research is underway to examine selected components of physical fitness, to explore their relationship with BMI and to inform interventional strategies and physical fitness goals for children and adolescents with CP. Identifying Health Disparities and Health Care Inequities Between Children With Special Health Care Needs With and Without Disabilities. Amy J. Houtrow, MD, MPH (University of California San Francisco, San Francisco, CA); Megumi J. Okumura, MD; Roberta S. Rehm, PhD, RN. Disclosures: A. J. Houtrow, None. Objective: Children with disabilities are among the most vulnerable members of society. Understanding the experiences of these children can help inform policies to improve health outcomes. The objective of this study was to compare children with special health care needs (CSHCN) with and without disabilities in terms of their health disparities and health care inequities. Design: Secondary data analysis was performed by using the National Survey of CSHCN, 2005-06. CSHCN with disabilities were identified by using the CSHCN Screener, which asked if the child had an ongoing limitation in his or her ability to do the things that other children of the same age can do due to a condition that has lasted or is expected to last at least 1 year. We stratified CSHCN by disability status for comparison purposes. Statistics were calculated by using STATA. Setting: National Survey of Children with Special Health Care Needs, 2005-06. Participants: A nationally representative sample of children with special health care needs, N⫽40,723. Interventions: None. Main Outcome Measures: Presence of disabilities by demographic characteristics. Differences in health status, health service use, unmet need, and care within a medical home by disability status. Results: 2.2 million CSHCN have disabilities. Blacks, Hispanics, publicly insured children, children living in poverty, and children raised by single parents are disproportionally affected by disability. The health conditions of CSHCN with disabilities compared with other CSHCN were more commonly deemed severe (26% vs 4%) and unstable (16%vs 4%). CSHCN with disabilities had higher rates of utilization and unmet need compared with other CSHCN. Less than a third of CSHCN with disabilities received care in a medical home compared with more than 50% of other CSHCN. Conclusions: This survey identified some important disparities and health care inequities among CSHCN. CSHCN
PRESENTATIONS
with disabilities have more adverse health consequences and have more difficulty accessing services, including care within a medical home. Health policies should assure that the needs of this population are met because these children are most at risk for negative consequences. Predicting Total Duration of Impaired Consciousness in Children With Traumatic Brain Injury. Stacy J. Suskauer, MD (Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, MD); Ellen DeMatt; Cynthia F. Salorio, PhD; Beth S. Slomine, PhD. Disclosures: S. J. Suskauer, None. Objective: To identify predictors of total duration of impaired consciousness in children with traumatic brain injury (TBI) who were undergoing inpatient rehabilitation. Design: Retrospective analysis of clinical data obtained over 10 years. Setting: Academically affiliated pediatric inpatient brain injury rehabilitation program. Participants: 110 children (3-18 years old) with moderate or severe TBI. Interventions: Not applicable. Main Outcome Measures: Time to follow commands (TFC) was defined as time from brain injury until the child was able to follow commands twice within a 24-hour period. Posttraumatic amnesia (PTA) was defined as the time from TFC until the child obtained 2 consecutive scores within 2 standard deviations of the age-based mean on the Children’s Orientation and Amnesia Test (COAT). Total duration of impaired consciousness was defined as TFC plus PTA. Results: Simple linear regression modeling revealed TFC⫹PTA (days) ⫽ 1.8 (TFC) ⫹ 10. TFC accounted for 75% of the variability in TFC⫹PTA (P⬍.001). In univariate regression models, other predictors of TFC⫹PTA included pre-resuscitation Glasgow Coma Scale score, cranial surgical intervention, and depth of lesion on clinical imaging. In a multiple regression model, only TFC survived as a predictor of TFC⫹PTA. Conclusions: TFC is an important predictor of total duration of impaired consciousness in children with moderate or severe TBI who require inpatient rehabilitation. This is the first known equation to estimate time to emergence from PTA derived from a cohort exclusively composed of children and may have important relevance for clinical care and research. Future work will be important to further define contributors to duration of impaired consciousness in this population and to investigate how the relationship between TFC and TFC⫹PTA differs among TBI populations, which vary with respect to factors including age and severity of injury.