Physical, Emotional and Social Recovery After Severe Paediatric Accidents: A Six-Month Follow-Up Study

Globally, unintentional accidents rank among the leading causes of death and disability in children. Despite adequate and appropriate care, survivors commonly experience significant physical and psychosocial sequelae.

To examine multi-domain health outcomes 6 months after paediatric intensive care unit admission in children sustaining severe unintentional accidents and to identify clinical, demographic and accident-related predictors of suboptimal recovery.

This prospective observational cohort study included children following severe unintentional accidents requiring critical care between 2021 and 2025. Health outcomes were assessed using the Pediatric Quality of Life Inventory 4.0 Generic Core (PedsQL; ages 2-18 years) and the PedsQL Infant Scales (ages 0-24 months). Parent-reported outcomes were collected 6 months post-injury. Multiple linear regression analyses identified predictors of less favourable outcomes.

A total of 195 children were included (age 7.1 [SD = 5.3] years, 66.2% male). Transport-related accidents (27.1%) and foreign body aspiration (20.5%) were most common. Mortality was 6.7% (N = 13). Among 170 respondents, PedsQL total score was 89.65 (SD = 15.2), physical health summary score was 90.67 (SD = 16.7) and the psychosocial health summary score was 88.27 (SD = 16.6). Prolonged hospitalization (β = -0.316, p = 0.002), older age (β = -0.207, p = 0.013), accident location (β = 0.160, p = 0.036) and injury mechanism (β = 0.199, p = 0.033) were independently associated with less favourable outcomes, explaining 26.4% of total score variance (R² = 0.264; adjusted R² = 0.227). Domain-specific analyses revealed variable predictors: older age (β = -0.268, p < 0.001) and extended hospitalization (β = -0.342, p < 0.001) predicted poorer physical health outcomes; female sex (β = -0.214, p = 0.004) and accident mechanism (β = 0.235, p = 0.017) predicted emotional difficulties; and accident site (β = 0.199, p = 0.014) and mechanism (β = 0.208, p = 0.034) predicted cognitive/school dysfunction.

Most children demonstrated substantial recovery at 6 months. However, older age, injury characteristics and prolonged hospitalization were associated with less favourable outcomes.

Identification of high-risk groups supports targeted, multi-domain follow-up and informs nursing-led, family-centred interventions after paediatric injury.