Researchers have found in a new study that functional status assessments can be limited to
cohorts of injured children and adolescents at the highest risk for impairment. Children and adolescents with extremity injuries and severe traumatic brain injuries comprised the largest proportions of those estimated to have impairment at discharge.
The study was published in the JAMA Surgery Network.
and long-term functional impairment after pediatric injury may be more
sensitive for measuring quality of care compared with mortality alone. The
characteristics of injured children and adolescents who are at the highest risk
for functional impairment are unknown.
Randall S. Burd and colleagues from the Division of Trauma and Burn Surgery,
Children’s National Medical Center, Washington, DC carried out the present study
to evaluate categories of injuries associated with higher prevalence of
impaired functional status at hospital discharge among children and adolescents
and to estimate the number of those with injuries in these categories who
received treatment at pediatric trauma centers.
prospective cohort study (Assessment of Functional Outcomes and Health-Related
Quality of Life After Pediatric Trauma) included children and adolescents
younger than 15 years who were hospitalized with at least 1 serious injury at 1
of 7 level 1 pediatric trauma centers.
least 1 serious injury (Abbreviated Injury Scale score, ≥3 [scores range from 1
to 6, with higher scores indicating more severe injury]) classified into 9
categories based on the body region injured and the presence of a severe
traumatic brain injury (Glasgow Coma Scale score <9 or Glasgow Coma Scale motor score <5) were the cases included.
following results were seen-
sample of 427 injured children and adolescents (271 [63.5%] male; median age,
7.2 years [interquartile range, 2.5-11.7 years]), 74 (17.3%) of whom had new
FSS domain morbidity at discharge.
proportion of new FSS domain morbidity was highest among those with multiple
injured body regions and severe head injury (20 of 24 [83.3%]) and lowest among
those with an isolated head injury of mild or moderate severity (1 of 84
adjusting for oversampling of specific injuries in the study sample, 749 of
5195 seriously injured children and adolescents (14.4%) were estimated to have
functional impairment at hospital discharge.
and adolescents with extremity injuries (302 of 749 [40.3%]) and those with
severe traumatic brain injuries (258 of 749 [34.4%]) comprised the largest
proportions of those estimated to have impairment at discharge.
the authors concluded that “In this cohort study, most injured children and
adolescents returned to baseline functional status by hospital discharge. These
findings suggest that functional status assessments can be limited to cohorts
of injured children and adolescents at the highest risk for impairment.”