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Published on: February 7, 2025
Functional and health-related quality of life outcomes after pediatric trauma
Belinda J Gabbe1, Pam M Simpson, Ann M Sutherland
1Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. belinda.gabbe@monash.edu
Insights
Pediatric trauma survivors experience lasting disability and reduced quality of life. The Child Health Questionnaire (CHQ-PF28) and Pediatric Quality of Life Inventory (PedsQL) effectively measure these outcomes.
Area of Science:
- Pediatric Traumatology
- Health Outcomes Research
- Quality of Life Measurement
Background:
- Pediatric trauma leads to significant long-term functional impairment and reduced health-related quality of life (HRQL).
- A lack of consensus exists on the optimal methods for measuring outcomes in pediatric trauma patients.
- Established outcome measures may not adequately capture the complexities of recovery in this population.
Purpose of the Study:
- To evaluate and compare the performance of multiple outcome measurement instruments in pediatric trauma survivors.
- To assess the trajectory of health-related quality of life (HRQL) and functional status at 1, 6, and 12 months post-injury.
- To identify the most suitable instruments for routine follow-up and research in pediatric trauma care.
Main Methods:
- 150 children admitted to a pediatric trauma center were assessed using the Pediatric Quality of Life Inventory (PedsQL), Child Health Questionnaire (CHQ-PF28), King's Outcome Scale for Childhood Head Injury (KOSCHI), modified Glasgow Outcome Scale (mGOS), and Functional Independence Measure (FIM).
- Data were collected via telephone at 1, 6, and 12 months post-injury.
- Multilevel mixed-effects models were used to analyze changes in instrument scores, with HRQL scores compared to population norms.
Main Results:
- At 12 months post-injury, significant ongoing disability was reported: 14% (FIM), 61% (mGOS), and 58% (KOSCHI).
- Health-related quality of life (HRQL) scores for the CHQ-PF28 physical and PedsQL psychosocial domains were below healthy child norms at 12 months.
- The KOSCHI, mGOS, CHQ-PF28 physical, and PedsQL psychosocial scores demonstrated improvement over the 12-month follow-up period.
Conclusions:
- Seriously injured children exhibit persistent disability and diminished HRQL one year after trauma.
- The CHQ-PF28 and PedsQL demonstrated comparable utility in assessing HRQL, while mGOS and KOSCHI showed similar performance in evaluating functional status.
- The FIM exhibited ceiling effects and failed to show improvement over time, suggesting limitations for this population. The findings support the use of CHQ-PF28, PedsQL, mGOS, and KOSCHI for pediatric trauma outcomes research and clinical follow-up.
Background:
Pediatric trauma results in lower mortality than adults and a high potential for lifelong functional impairment and reduced health-related quality of life (HRQL). There is no consensus regarding the best approach to measuring outcomes in this group.
Methods:
One hundred and fifty injured children admitted to a pediatric trauma center participated in this study. The Pediatric Quality of Life Inventory (PedsQL), Child Health Questionnaire (CHQ-PF28), King's Outcome Scale for Childhood Head Injury (KOSCHI), modified Glasgow Outcome Scale (mGOS), and the Functional Independence Measure (FIM) were administered at 1 month, 6 months, and 12 months after injury by telephone. Change in instrument scores was assessed using multilevel mixed effects models. Mean HRQL scores were compared with population norms for the CHQ-PF28 and with healthy children for the PedsQL.
Results:
Follow-up at all time points was completed for 144 (96%) cases. The median injury severity score was 10, and 65% of the patients enrolled were men. At 12 months, the percentage of cases with ongoing disability was 14% for the FIM, 61% using the mGOS, and 58% for the KOSCHI. CHQ-PF28 physical and PedsQL psychosocial health scores were below healthy child norms at 12 months. Improvement across all time points was demonstrated for the KOSCHI, mGOS, CHQ-PF28 physical, and PedsQL psychosocial summary scores.
Conclusions:
Seriously injured children showed ongoing disability and reduced HRQL 12 months after injury. The CHQ-PF28 and PedsQL, and the mGOS and KOSCHI, performed comparably. The FIM demonstrated considerable ceiling effects, and improvement over time was not shown. The results inform the methodology of pediatric outcomes studies and protocol development for the routine follow-up of pediatric trauma patients.
