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Function and Quality of Life 5 Years Following Pediatric Major Trauma: A Population-Based Cohort Study
Shanthi N Ameratunga1,2, James E Harrison3, Peter Cameron2
1From the Section of Epidemiology & Biostatistics, School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
Insights
Many children surviving major trauma face long-term disability, particularly in psychosocial health-related quality of life (HRQL). Identifying predictors early can guide interventions for better pediatric trauma outcomes.
Area of Science:
- Pediatric Traumatology
- Rehabilitation Medicine
- Public Health
Background:
- Increasing survival rates in pediatric major trauma necessitate understanding long-term functional outcomes.
- Existing 1-2 year follow-up studies offer conflicting data on the long-term trajectory of pediatric trauma survivors.
- A comprehensive 5-year follow-up is crucial to delineate functional recovery and health-related quality of life (HRQL).
Purpose of the Study:
- To evaluate the functional and health-related quality of life (HRQL) trajectories over 5 years post-pediatric major trauma.
- To identify predictors associated with long-term outcomes in pediatric trauma survivors.
- To inform the development of targeted interventions for improved pediatric trauma care.
Main Methods:
- A prospective, population-based 5-year follow-up study of pediatric (<18 years) major trauma patients in Australia.
- Data collection at 6, 12, 24, 36, 48, and 60 months using validated instruments: King's Outcome Scale for Childhood Head Injury and Pediatric Quality of Life Inventory (PedsQL).
- Multivariable regression analyses to determine associations between predictors and 5-year outcomes.
Main Results:
- Data from 132 of 186 (71%) survivors were analyzed over 5 years.
- Significant improvements in function and HRQL were observed, yet 39% experienced moderate to severe disability at 5 years.
- Psychosocial HRQL scores were notably lower than physical scores and population norms, indicating a specific area of concern.
Conclusions:
- A substantial proportion of pediatric major trauma survivors experience persistent moderate to severe disability.
- Psychosocial health-related quality of life recovery lags behind physical function recovery.
- Predictors of adverse outcomes, identifiable during acute care, offer opportunities for early intervention and risk mitigation.
Objective:
To evaluate trajectories and predictors of function and health-related quality of life (HRQL) in the 5 years following pediatric major trauma.
Background:
While increasing proportions of children survive major trauma, largely trauma center-based, 1- to 2-year follow-up studies yield conflicting evidence regarding their long-term outcomes.
Methods:
This population-based prospective 5-year follow-up study was designed to recruit all consecutive pediatric (<18 years) major trauma patients registered in Australia's Victorian State Trauma Registry over a 12-month period. At 6, 12, 24, 36, 48, and 60 months postinjury, parents were interviewed to obtain children's function and HRQL using King's Outcome Scale for Childhood Head Injury and Pediatric Quality of Life Inventory (PedsQL), respectively. Multivariable regression models were used to investigate the associations between 5-year outcomes and potential predictors.
Results:
Of 199 eligible patients, 5 years of follow-up data were available for 132 of 186 (71%) survivors. Children's function and HRQL improved throughout the follow-up period. At 5 years postinjury: 39% had fully recovered, while 39% experienced moderate to severe disability. The mean PedsQL physical score (89.0; SD:18.6) approximated population norms, while the psychosocial score was significantly lower (85.5; SD:16.9). Adverse outcomes were associated with older age, female sex, lower socioeconomic status, residence outside metropolitan areas, preexisting comorbidities, and injuries deemed intentional, compensable, or head trauma.
Conclusions:
A high proportion of children surviving major trauma experience moderate to severe long-term disability, with psychosocial HRQL lagging recovery of physical function. Prognostic factors are identifiable during acute admission, providing opportunities to develop clinical prediction rules and tailored interventions that mitigate inequitable risks of adverse outcomes.
