Randall S Burd1, Aaron R Jensen2, John M VanBuren3, Jessica S Alvey3, Rachel Richards3, Richard Holubkov3, Murray M Pollack4. 1. Division of Trauma and Burn Surgery, Children's National Medical Center. Electronic address: rburd@childrensnational.org. 2. UCSF Benioff Children's Hospital Oakland, Oakland, CA. 3. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 4. Department of Pediatrics, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington DC.
Abstract
BACKGROUND: Disability and impaired health-related quality of life can persist for months among injured children. Previous studies of long-term outcomes have focused mainly on children with specific injury types rather than those with multiple injured body regions. This study's objective was to determine the long-term functional status and health-related quality of life after serious pediatric injury, and to evaluate the associations of these outcomes with features available at hospital discharge. STUDY DESIGN: We conducted a prospective observational study at 7 Level I pediatric trauma centers of children treated for at least 1 serious (Abbreviated Injury Scale severity 3 or higher) injury. Patients were sampled to increase the representation of less frequently injured body regions and multiple injured body regions. Six-month functional status was measured using the Functional Status Scale (FSS) and health-related quality of life using the Pediatric Quality of Life Inventory. RESULTS: Among 323 injured children with complete discharge and follow-up assessments, 6-month FSS score was abnormal in 33 patients (10.2%)-16 with persistent impairments and 17 previously normal at discharge. Increasing levels of impaired discharge FSS score were associated with impaired FSS and lower Pediatric Quality of Life Inventory scores at 6-month follow-up. Additional factors on multivariable analysis associated with 6-month FSS impairment included older age, penetrating injury type, severe head injuries, and spine injuries, and included older age for lower 6-month Pediatric Quality of Life Inventory scores. CONCLUSIONS: Older age and discharge functional status are associated with long-term impairment of functional status and health-related quality of life. Although most seriously injured children return to normal, ongoing disability and reduced health-related quality of life remained 6 months after injury. Our findings support long-term assessments as standard practice for evaluating the health impacts of serious pediatric injury.
BACKGROUND: Disability and impaired health-related quality of life can persist for months among injured children. Previous studies of long-term outcomes have focused mainly on children with specific injury types rather than those with multiple injured body regions. This study's objective was to determine the long-term functional status and health-related quality of life after serious pediatric injury, and to evaluate the associations of these outcomes with features available at hospital discharge. STUDY DESIGN: We conducted a prospective observational study at 7 Level I pediatric trauma centers of children treated for at least 1 serious (Abbreviated Injury Scale severity 3 or higher) injury. Patients were sampled to increase the representation of less frequently injured body regions and multiple injured body regions. Six-month functional status was measured using the Functional Status Scale (FSS) and health-related quality of life using the Pediatric Quality of Life Inventory. RESULTS: Among 323 injured children with complete discharge and follow-up assessments, 6-month FSS score was abnormal in 33 patients (10.2%)-16 with persistent impairments and 17 previously normal at discharge. Increasing levels of impaired discharge FSS score were associated with impaired FSS and lower Pediatric Quality of Life Inventory scores at 6-month follow-up. Additional factors on multivariable analysis associated with 6-month FSS impairment included older age, penetrating injury type, severe head injuries, and spine injuries, and included older age for lower 6-month Pediatric Quality of Life Inventory scores. CONCLUSIONS: Older age and discharge functional status are associated with long-term impairment of functional status and health-related quality of life. Although most seriously injured children return to normal, ongoing disability and reduced health-related quality of life remained 6 months after injury. Our findings support long-term assessments as standard practice for evaluating the health impacts of serious pediatric injury.
Authors: Joseph V Sakran; Hiba Ezzeddine; C William Schwab; Stephanie Bonne; Karen J Brasel; Randall S Burd; Joseph Cuschieri; James Ficke; Barbara A Gaines; Joseph T Giacino; Nicole S Gibran; Adil Haider; Erin C Hall; Juan P Herrera-Escobar; Bellal Joseph; Lillian Kao; Brad G Kurowski; David Livingston; Samuel P Mandell; Deepika Nehra; Babak Sarani; Mark Seamon; Peter Yonclas; Ben Zarzaur; Ronald Stewart; Eileen Bulger; Avery B Nathens Journal: J Am Coll Surg Date: 2020-03-19 Impact factor: 6.113
Authors: Brian F Flaherty; Margaret L Jackson; Charles S Cox; Amy Clark; Linda Ewing-Cobbs; Richard Holubkov; Kevin R Moore; Rajan P Patel; Heather T Keenan Journal: J Pediatr Surg Date: 2019-07-08 Impact factor: 2.545
Authors: Leila R Zelnick; Laurie J Morrison; Sean M Devlin; Eileen M Bulger; Karen J Brasel; Kellie Sheehan; Joseph P Minei; Jeffrey D Kerby; Samuel A Tisherman; Sandro Rizoli; Riyad Karmy-Jones; Rardi van Heest; Craig D Newgard Journal: J Neurotrauma Date: 2014-05-08 Impact factor: 5.269
Authors: Suzanne Polinder; Juanita A Haagsma; Hidde Toet; Marco J P Brugmans; Ed F van Beeck Journal: BMC Public Health Date: 2010-01-29 Impact factor: 3.295
Authors: Heather T Keenan; Amy E Clark; Richard Holubkov; Charles S Cox; Linda Ewing-Cobbs Journal: J Neurotrauma Date: 2017-10-16 Impact factor: 5.269
Authors: Sage R Myers; Charles C Branas; Benjamin French; Michael L Nance; Brendan G Carr Journal: Pediatr Emerg Care Date: 2019-01 Impact factor: 1.454
Authors: Belinda J Gabbe; Pam M Simpson; Ann M Sutherland; Owen D Williamson; Rodney Judson; Thomas Kossmann; Peter A Cameron Journal: Ann Surg Date: 2008-05 Impact factor: 12.969
Authors: Jerry J Zimmerman; Russell Banks; Robert A Berg; Athena Zuppa; Christopher J Newth; David Wessel; Murray M Pollack; Kathleen L Meert; Mark W Hall; Michael Quasney; Anil Sapru; Joseph A Carcillo; Patrick S McQuillen; Peter M Mourani; Hector Wong; Ranjit S Chima; Richard Holubkov; Whitney Coleman; Samuel Sorenson; James W Varni; Julie McGalliard; Wren Haaland; Kathryn Whitlock; J Michael Dean; Ron W Reeder Journal: Crit Care Med Date: 2020-03 Impact factor: 7.598
Authors: Murray M Pollack; Richard Holubkov; Penny Glass; J Michael Dean; Kathleen L Meert; Jerry Zimmerman; Kanwaljeet J S Anand; Joseph Carcillo; Christopher J L Newth; Rick Harrison; Douglas F Willson; Carol Nicholson Journal: Pediatrics Date: 2009-07 Impact factor: 7.124