Psychological distress and healthcare costs of pediatric mTBI

Child in Hospital Bed

Although pediatric mTBI patients are not usually hospitalized, it is still expected that there will be some increase in TBI-related medical costs. Mild traumatic brain injuries are complex and outcomes can vary greatly-making a prediction of financial burden difficult to pinpoint. Past studies that have explored the financial burden of mTBI have been limited by variations in recovery time and complications due to cases of psychological distress.

Recovery from mTBI is still a controversial subject. There have been many reports of full recovery from mTBI within 3 months of injury. However, more recent studies have shown that some cognitive and behavioral symptoms can persist for years.

Psychological distress-as defined by clinical diagnoses such as depression or anxiety, psychotic mental disorders, hallucinations, hyperactivity, or substance abuse-can complicate the diagnosis and outcome of mTBI, regardless if the condition is pre-existing or post-injury.

A recent study published in Brain Injury specifically addressed these research limitations. Hospital records were investigated to look at a period of one year before injury in order to establish evidence of pre-existing psychological distress, and for three years after in order to determine new cases of psychological distress, as well as recovery time and outcome.

Their results were as follows:

  1. Injured children had approximately 75% greater medical costs than uninjured children.
  2. Injured children who showed evidence of psychological distress had nearly 3 times the medical costs of children who showed no evidence of psychological distress. These figures were controlled for pre-existing cases of psychological distress.
  3. One-third of the total medical costs occurred within 6 months of injury. More than half the total medical costs occurred within one year of injury.

It was not examined if mTBI had a direct link to new cases of psychological disorders, and it is possible that increased exposure to medical facilities increased new diagnoses of previously undiagnosed psychological disorders. After being controlled for recovery time and psychological distress, it remains that pediatric mTBI treatment is expensive and requires comprehensive, ongoing treatment for at least a year after injury.

Rockhill CM, Fann JR, Fan M-Y, Hollingworth W, & Katon WJ. Healthcare costs associated with mild traumatic brain injury and psychological distress in children and adolescents. Brain Injury. (July 2010).