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Functional limitations and recovery in children with severe trauma: a one-year follow-up
1Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Many children with severe trauma experience long-term functional limitations, with recovery varying by injury type. Self-care shows higher recovery rates, but overall outcomes depend more on body parts affected than the Injury Severity Score (ISS).
Area of Science:
- Pediatric Traumatology
- Rehabilitation Medicine
- Functional Outcomes Research
Background:
- Severe trauma in children can lead to significant functional limitations.
- Understanding recovery trajectories and influencing factors is crucial for pediatric trauma care.
- Existing data on long-term functional status and recovery in pediatric trauma survivors is limited.
Purpose of the Study:
- To assess functional limitations and recovery rates in children following severe trauma.
- To investigate the association between functional outcomes and Injury Severity Scores (ISS).
- To identify factors influencing functional recovery in pediatric trauma patients.
Main Methods:
- A longitudinal study followed 92 children with severe trauma and 59 controls (appendicitis).
- Functional limitations and physical health status were assessed using the Rand Health Insurance Study instrument at 6 months and 1 year post-discharge.
- Injury Severity Scores (ISS) were analyzed in relation to functional status and recovery.
Main Results:
- 73% and 55% of trauma patients had functional limitations at 6 months and 1 year, respectively, compared to 14% and 9% of controls.
- Trauma patients showed functional status improvements of 22% (6 months) and 24% (1 year).
- Higher ISS correlated with impairment for head or face-chest-abdomen injuries, but not extremity injuries. Self-care recovery rates were high (73% and 46%).
Conclusions:
- Children surviving severe trauma often face persistent functional limitations.
- Recovery rates are not uniform and are influenced by the type of functional limitation and body part affected.
- Injury Severity Score (ISS) is less predictive of overall functional status than the specific body regions impacted by the trauma.
Abstract:
To examine functional limitations, recovery rates, and association with Injury Severity Scores (ISSs), we followed 92 children with severe trauma and 59 control subjects with appendicitis at 6 months and 1 year after discharge. Physical health status was assessed by the Rand Health Insurance Study instrument. Overall, 73% and 55% of trauma patients had one or more functional limitations at 6 months and 1 year, respectively, in contrast to 14% and 9% of the controls. Overall functional status of the trauma patients improved by 22% in the first 6 months and 24% in the second. Much higher recovery rates (73% and 46%) were noted for self care. Although ISS did not correlate with overall functional status, higher ISSs were related to impairment in patients whose principal injury was to the head or the face-chest-abdomen but not in those whose principal injury was to an extremity. This study shows that many children with severe trauma are left with disabilities. Recovery rates are not uniform but depend on type of limitation. Functional impairment and recovery are related more to the body parts involved than to ISS.