Kate Curtis1, Belinda Kennedy2, Mary K Lam3, Rebecca J Mitchell4, Deborah Black5, Brian Burns6, Leslie White4, Allan Loudfoot7, Alfa D'Amato8, Michael Dinh9, Andrew J A Holland10. 1. Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, MO2 88 Mallett St, NSW 2006, Australia. 2. Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, MO2 88 Mallett St, NSW 2006, Australia. Electronic address: Belinda.kennedy@sydney.edu.au. 3. Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Australia. 4. Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Rd, North Ryde NSW 2113, Australia. 5. Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia. 6. Greater Sydney Area HEMS, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport NSW 2200, Australia. 7. NSW Ambulance, Locked bag 105, Rozelle NSW 2039, Australia. 8. System Financial Performance and Deputy CFO, NSW Ministry of Health; UTS Business School, Sydney, Australia. 9. NSW Institute of Trauma and Injury Management (ITIM), Agency for Clinical Innovation, Level 4/67 Albert Ave, Chatswood NSW 2067, Australia. 10. The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia.
Abstract
BACKGROUND: Information about children treated in New South Wales (NSW), Australia following major injury has been limited to those treated at trauma centres using mortality as the main outcome measure, restricting assessment of the effectiveness of the Trauma System. This study sought to describe the detailed characteristics as well as functional and psychosocial health outcomes of all children suffering major injury in NSW. METHODS: A longitudinal study was conducted between July 2015 and November 2017 and included children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW or who died following injury. Children were identified through the three NSW Paediatric Trauma Centres (PTC), the NSW Trauma Registry, NSW Aeromedical Retrieval Registry (AirMaestro) and the National Coronial Information System (NCIS). Health-related quality of life (HRQoL) outcomes for children treated at the three PTCs were collected at baseline, 6 and 12 months using the Paediatric Quality of Life inventory (PedsQL 4.0) and EuroQol five-dimensional EQ-5D-Y. RESULTS: There were 625 children, with a median (interquartile range) age of 7 (2-13) years and 71.7% were male. Around half were injured in major cities (51.2%). The median (IQR) injury severity score (ISS) was 10 (9-17). Twelve-month HRQoL measured by PedsQL remained below baseline for psychosocial health. Treatment costs increased with injury severity (p=<0.001) and polytrauma (p=<0.001). No survival benefit was demonstrated between PTC versus non-PTC definitive care. Injured females and children from rural / remote NSW were overrepresented in the deceased. CONCLUSION: Children treated in NSW following major injury have reduced quality of life and in particular, reduced emotional well-being at 12 months post-injury. Improved psychosocial care and outpatient follow-up is required to minimise the long-term emotional impact of injury on the child.
BACKGROUND: Information about children treated in New South Wales (NSW), Australia following major injury has been limited to those treated at trauma centres using mortality as the main outcome measure, restricting assessment of the effectiveness of the Trauma System. This study sought to describe the detailed characteristics as well as functional and psychosocial health outcomes of all children suffering major injury in NSW. METHODS: A longitudinal study was conducted between July 2015 and November 2017 and included children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW or who died following injury. Children were identified through the three NSW Paediatric Trauma Centres (PTC), the NSW Trauma Registry, NSW Aeromedical Retrieval Registry (AirMaestro) and the National Coronial Information System (NCIS). Health-related quality of life (HRQoL) outcomes for children treated at the three PTCs were collected at baseline, 6 and 12 months using the Paediatric Quality of Life inventory (PedsQL 4.0) and EuroQol five-dimensional EQ-5D-Y. RESULTS: There were 625 children, with a median (interquartile range) age of 7 (2-13) years and 71.7% were male. Around half were injured in major cities (51.2%). The median (IQR) injury severity score (ISS) was 10 (9-17). Twelve-month HRQoL measured by PedsQL remained below baseline for psychosocial health. Treatment costs increased with injury severity (p=<0.001) and polytrauma (p=<0.001). No survival benefit was demonstrated between PTC versus non-PTC definitive care. Injured females and children from rural / remote NSW were overrepresented in the deceased. CONCLUSION:Children treated in NSW following major injury have reduced quality of life and in particular, reduced emotional well-being at 12 months post-injury. Improved psychosocial care and outpatient follow-up is required to minimise the long-term emotional impact of injury on the child.