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Published on: September 21, 2017
Disability risk in pediatric motor vehicle crash occupants
Andrea N Doud1, Samantha L Schoell, Ashley A Weaver
1From the Department of General Surgery (A.N.D., J.K.P.), Wake Forest School of Medicine; Childress Institute for Pediatric Trauma (A.N.D.); Department of Biomedical Engineering (S.L.S., A.A.W., J.D.S.), and the Division of Public Health Sciences (J.W.T., R.T.B.), Wake Forest School of Medicine, Winston-Salem, North Carolina.
Insights
A new pediatric-specific disability risk (DR) metric helps assess nonfatal injuries in children after motor vehicle crashes (MVCs). This metric improves understanding of injury severity and potential long-term disability, crucial for pediatric triage.
Area of Science:
- Trauma research
- Pediatric injury epidemiology
- Biostatistics
Background:
- Motor vehicle crashes (MVCs) pose risks for pediatric nonfatal injuries with varying disability levels.
- Existing metrics may not fully capture the severity of nonfatal injuries in children.
- A pediatric-specific disability risk (DR) metric was developed to address this gap.
Purpose of the Study:
- To create and validate a pediatric-specific disability risk (DR) metric for nonfatal injuries sustained in motor vehicle crashes (MVCs).
- To improve the discrimination of injury severity beyond mortality risk in pediatric MVC occupants.
- To inform the development of advanced pediatric triage algorithms.
Main Methods:
- Utilized the National Automotive Sampling System (2000-2011) to identify common Abbreviated Injury Scale (AIS) 2+ injuries in pediatric MVC occupants.
- Abstracted Functional Independence Measure scores from the National Trauma Data Bank (2002-2006).
- Calculated disability risk (DR) and coinjury-adjusted DR (DRMAIS) for common AIS 2+ injuries in children aged 7-18 years.
Main Results:
- The mean DR and DRMAIS across all injuries were 0.290 and 0.191, respectively.
- Head, thorax, and spine injuries exhibited the highest DR and DRMAIS values.
- Disability risk increased with AIS severity, though significant variation existed across severity levels.
Conclusions:
- Integrating DR metrics into injury severity assessments can enhance the differentiation of nonfatal injury severity in children.
- Accurate severity metrics are vital for effective pediatric triage, particularly for algorithms like Advanced Automatic Crash Notification.
- The pediatric DR metric is crucial for quantifying long-term disability impact in young populations.
Background:
Mortality rates among children in motor vehicle crashes (MVCs) are typically low; however, nonfatal injuries can vary in severity by imposing differing levels of short- and long-term disability. To better discriminate the severity of nonfatal MVC injuries, a pediatric-specific disability risk (DR) metric was created.
Methods:
The National Automotive Sampling System 2000 to 2011 was used to define the top 95% most common Abbreviated Injury Scale (AIS) 2+ injuries among pediatric MVC occupants. Functional Independence Measure scores were abstracted from the National Trauma Data Bank 2002 to 2006. Multiple imputation was used to account for missing data. The DR and coinjury-adjusted DR (DRMAIS) of the most common AIS 2+ MVC-induced injuries were calculated for 7-year-old to 18-year-old children by determining the proportion of those disabled after an injury to those sustaining the injury. DR and DRMAIS values ranged from 0 to 1, representing 0% to 100% DR.
Results:
The mean DR and DRMAIS of all injuries were 0.290 and 0.191, respectively. DR and DRMAIS were greatest for injuries to the head (DR, 0.340; DRMAIS, 0.279), thorax (DR, 0.320; DRMAIS, 0.233), and spine (DR, 0.315; DRMAIS, 0.200). The mean DR and DRMAIS increased with increasing AIS severity but there was significant variation and overlapping values across AIS severity levels. Comparison of DRMAIS to coinjury-adjusted mortality risk (MRMAIS) revealed that among 118 injuries with MRMAIS of 0.000, DRMAIS ranged from 0.000 to 0.429.
Conclusion:
Incorporation of DR metrics into injury severity metrics may improve the ability to distinguish between the severity of different nonfatal injuries. This is especially crucial in the pediatric population where permanent disability can result in a high number of years lost due to disability. The accuracy of such severity metrics is crucial to the success of pediatric triage algorithms such as Advanced Automatic Crash Notification algorithms.
Level Of Evidence:
Epidemiologic/prognostic study, level III.
