1552 - Brainstorming: A Retrospective Chart Review on Admission Trends and Rehabilitation Courses for Pediatric Patients with Gunshot Wounds to the Head

Objectives: Gunshot wounds (GSW) to the head are the most lethal of penetrating brain injuries and, compared to pediatric traumatic brain injuries (TBI) of other etiologies, outcomes after GSW are poor. Fortunately, the pediatric brain has greater potential for development, reorganization, and neuroplasticity. Our neurosurgical colleagues initially researched surgical complications of these patients. Next, we assessed rehabilitation related data. This study aimed to identify trends relevant to post-acute care disposition for pediatric GSW to the head and evaluate pediatric Functional Independence Measures (WeeFIM) in those who underwent acute inpatient rehabilitation (AIR).

Design: Retrospective chart review at an academic institution. Frequency and descriptive statistics were calculated on all variables. ANOVA or Kruskal Wallis tests were used to test differences between discharge groups. Paired sample t-test was used to test differences between admission and discharge rehabilitation (WeeFIM) data. Alpha level of 0.05 was set for all analyses.

Results: Nineteen patients met inclusion criteria. On discharge, 8 went home, 7 to AIR, and 4 to other facilities. These discharge settings were compared to patient demographics, findings on initial presentation, and selected characteristics during hospital stay. Differences in length of stay (LOS), intraparenchymal bullet trajectory, and presence of infection during hospitalization were found to be statistically significant between groups. The subset of patients discharged to AIR experienced statistically significant functional improvements in the vast majority of WeeFIM domains including self-care, mobility, and cognition, over an average LOS of 24.5 days.

Conclusions: LOS, intraparenchymal bullet trajectory, and presence of infection may be good indicators for AIR admission after GSW to the head. AIR may expedite improvements in function and decrease long term disability. This study established baseline data for pediatric inpatient rehabilitation outcomes. Ideally, the long-term goal is to develop interdisciplinary algorithms to determine the appropriate patients for rehabilitation, the timing of rehabilitation, and the focus of rehabilitation.