Quality of life and functional outcome after pediatric trauma.
BACKGROUND
Injury is the leading cause of preventable morbidity and functional limitation in children. Long-term sequelae are measured best by the degree of impairment after recovery from the acute traumatic event. The specific aim of this study was to determine the quality of life and functional status of moderately to severely injured pediatric trauma patients at hospital discharge and at 1, 6, and 12 months postinjury.


METHODS
We conducted a prospective longitudinal study of children aged 1 to 18 years with blunt injury and Injury Severity Score >/= 9, excluding head and spinal cord injury. Children were evaluated at hospital discharge and at 1, 6, and 12 months postinjury, using the Child Health Questionnaire (CHQ), the Functional Independence Measure, and the Impact on Family Scale. Baseline and 1- and 6-month data analyses are reported.


RESULTS
One hundred sixty-two children were enrolled in the study, and 156 had completed 6-month data entry. The mean age was 9.3 +/- 5.3 years, and the mean Injury Severity Score was 14 +/- 7.4. The most common cause of injury was motor vehicular-related (43%). Fifty-eight (37%) had multisystem injuries. Femur fracture represented the most common injury (54.8%). Families experienced economic, social, and personal strain, as measured by the Impact on Family scale. There was a significant improvement in CHQ and Functional Independence Measure scores between baseline and 1 month and between 1 month and 6 months postinjury. However, at 6 months, physical scores remained lower than age-matched norms.


CONCLUSIONS
Injury in children results in a significant burden on families. Although children demonstrate a rapid recovery of function and quality of life after blunt injury, physical function remains lower than age-matched norms at 6 months postinjury. It is unclear whether this represents a plateau in recovery or whether further improvements can be expected over longer time intervals.
Winthrop
Andrea L
AL
Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. winthrop@mcw.edu
Brasel
Karen J
KJ
Stahovic
Linda
L
Paulson
Justin
J
Schneeberger
Benjamin
B
Kuhn
Evelyn M
EM
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000293:Adolescent; D001294:Attitude to Health; D015984:Causality; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005190:Family / Q000523:psychology; D005260:Female; D006304:Health Status; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D011446:Prospective Studies; D002666:Psychology, Child; D011788:Quality of Life; D020127:Recovery of Function; D018434:Sickness Impact Profile; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014922:Wisconsin; D014949:Wounds, Nonpenetrating / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*